Insulin analogs and methods of using the same

ABSTRACT

Insulin (INS) analogs are disclosed including modifications that increase half-life when compared to native, human INS, that maintain selectivity to the insulin receptor (IR) and that provide in vitro and in vivo stability for improved druggability properties and less immunogenicity. Pharmaceutical compositions also are disclosed that include one or more of the INS analogs described herein in a pharmaceutically acceptable carrier. Methods of making and using the INS analogs also are disclosed, especially for treating metabolic CA conditions, diseases or disorders, especially treating diseases such as diabetes and obesity.

The disclosure relates generally to biology and medicine, and more particularly it relates to insulin (INS) analogs, especially long-acting, single-chain INS (SCI) analogs that can bind to an INS receptor (IR), thereby functioning as IR agonists. The disclosure further relates to compositions including the same and their use in treating metabolic conditions, diseases or disorders such as diabetes and obesity.

INS is a peptide hormone secreted by pancreatic beta (p) cells that physiologically acts to maintain normal blood glucose levels by facilitating cellular glucose uptake and by concomitantly suppressing hepatic gluconeogenesis, thereby regulating carbohydrate, lipid and protein metabolism. Additionally, INS promotes cell division and growth in a fed state.

Structurally, INS is a heterodimer of two peptide chains of twenty-one and thirty amino acids (A chain and B chain, respectively) linked by two interchain disulfide bonds with the A chain further having one intrachain disulfide bond. INS is produced from its prohormone, proinsulin, by cleaving a C peptide therefrom. See, e.g., De Meyts (2004) Bioessays 26:1351-1362; and Wilcox (2005) Clin. Biochem. Rev. 26:19-39.

Therapeutically, there are six main types of INS including, (1) rapid-acting INS, (2) short-acting (prandial) INS, (3) intermediate-acting INS, (4) long-acting (basal) INS, (5) combination/pre-mixed INS and (6) inhaled INS. Effective INS therapy for individuals having diabetes typically is a combination of two types of exogenous INS formulations—a short-acting (prandial) INS administered at mealtime and a long-acting (basal) INS administered once or twice daily to control blood glucose levels between meals.

A number of INS analogs exist having an extended t½ when compared to native INS so that they can be administered as long-acting (basal) INS. For example, Intl. Patent Application Publication Nos. WO 1995/007931 and WO 2018/217573 describe INS analogs that include INS and variants thereof linked to fatty acid moieties (i.e., acylated) to improve t½. U.S. Pat. No. 5,656,722 describes INS analogs that include an Asp21Gly mutation of the A-chain and a carboxy-terminal extension of B-chain by two Arg residues. Intl. Patent Application Publication No. WO 2005/012347 describes INS analogs that are hexamers resulting from adding hexadecanedioic acid to a Lys at 29 position of the B chain. Duttaroy et al. describes analogs that include human INS linked to human serum albumin to improve t2 (see, Duttaroy et al. (2005) Diabetes 54:251-258). CN Patent No. 103509118 and Intl. Patent Application Publication No. WO 2016/178905 describe INS analogs that are fusions of the A chain and/or B chain that further include a Fc moiety to improve t½.

Despite the vast number of INS analogs, there is a need for additional INS analogs having an improved t½, especially analogs for use as long-acting (basal) INS.

To address this need, the disclosure first describes SCI analogs having activity at an IR, which thereby can act as IR agonists. Such SCI analogs include a basic structure from an amino-terminus (N-terminus) to a carboxy-terminus (C-terminus) of:

VHH-L₁-A-L₂-B,

VHH-L₁-B-L₂-A,

A-L₂-B-L₁-VHH, or

B-L₂-A-L₁-VHH,

where VHH is a moiety acting as a pharmacokinetic enhancer, A is an INS A chain, B is an INS B chain, L₁ is a first linker, and L₂ is a second linker.

In some instances, the VHH moiety can have an amino acid sequence of SEQ ID NO:7, 8 or 9. In other instances, the VHH moiety can be a variant having one or more additions, deletions, insertions or substitutions such that the VHH moiety has an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NOS:7, 8 or 9.

In some instances, the A chain can have an amino acid sequence of SEQ ID NO:3. In other instances, the A chain can be a variant having one or more additions, deletions, insertions or substitutions such that the A chain has an amino acid sequence having at least about 90% to about 99% sequence similarity to any one of SEQ ID NO:3. For example, the A chain can include a E4Q mutation, T8H mutation, a Y14E mutation or a N21G mutation of SEQ ID NO:3.

In some instances, the B chain can have an amino acid sequence of SEQ ID NO:4. In other instances, the B chain can be a variant having one or more additions, deletions, insertions or substitutions such that the B chain has an amino acid sequence having at least about 90% to about 99% sequence similarity to any one of SEQ ID NO:4. For example, the B chain can include a N3D mutation, a N3K mutation, a N3S mutation, a S9A mutation, a Y16E mutation, a Y16F mutation, a Y16H mutation, a Y16R mutation, a Y16W mutation, a E21Q mutation or a F25H mutation of SEQ ID NO:4.

In some instances, L₁ can have an amino acid sequence of (GGGGQ)_(n)(SEQ ID NO:10), (GGGQ)_(n)(SEQ ID NO:11), (GGGGS)_(n)(SEQ ID NO:12), (PGPQ)_(n)(SEQ ID NO:13), (PGPA)_(n) (SEQ ID NO:14), (GGE)_(n)GG (SEQ ID NO:15), (GGGGE)_(n)GGGG (SEQ ID NO:16), (GGGGK)_(n)GGGG (SEQ ID NO:17), GGGG(AP)_(n)GGGG (SEQ ID NO:18), GGGG(EP)_(n)GGGG (SEQ ID NO:19), GGGG(KP)_(n)GGGG (SEQ ID NO:20), (PGPE)_(n)PGPQ (SEQ ID NO:21), (PGPK)_(n)PGPQ (SEQ ID NO:22), where n can be from 1 to 10. In other instances, L₁ can have an amino acid sequence of any one of SEQ ID NOS:23 to 33. In still other instances, L₁ can be a variant having one or more additions, deletions, insertions or substitutions such that L₁ has an amino acid sequence having at least about 90% to about 99% sequence similarity to any one of SEQ ID NOS:23 to 33.

In some instances, L₂ can have an amino acid sequence of any one of SEQ ID NOS:34 to 36. In other instances, L₂ can be a variant having one or more additions, deletions, insertions or substitutions such that L₂ has an amino acid sequence having at least about 90% to about 99% sequence similarity to any one of SEQ ID NOS:34 to 36.

In certain instances, the INS analogs can have an amino acid sequence that includes a VHH of SEQ ID NO:7 or 8; an A chain of SEQ ID NO:3 or a variant thereof, a B chain of SEQ ID NO:4 or a variant thereof, a L₁ of any one of SEQ ID NO:23 to 33 and a L₂ of any one of SEQ ID NO:34 to 36. Alternatively, the INS analogs can have an amino acid sequence having at least about 90% to about 99% sequence similarity to an amino acid sequence that includes a VHH of SEQ ID NO:7 or 8; an A chain of SEQ ID NO:3 or a variant thereof, a B chain of SEQ ID NO:4 of a variant thereof, a L₁ of any one of SEQ ID NOS:23 to 33; and a L₂ of any one of SEQ ID NOS:34 to 36.

In particular instances, the INS analogs can have an amino acid sequence of any one of SEQ ID NOS:37 to 81. Alternatively, the INS analogs can have an amino acid sequence having at least about 90% to about 99% sequence similarity to an amino acid sequence of any one of SEQ ID NOS:37 to 81.

In some instances, the VHH moiety can bind serum albumin, especially human serum albumin, and can include a complementarity-determining region 1 (CDR1), a complementarity-determining region 2 (CDR2) and a complementarity-determining region 3 (CDR3), where CDR1 can have an amino acid sequence of SEQ ID NOS:84, 85 or 86, where CDR2 can have an amino acid sequence of SEQ ID NOS:87, 88 or 89, and CDR3 can have an amino acid sequence of SEQ ID NOS:90, 91 or 92. In certain instances, the VHH moiety can include a CDR1 of SEQ ID NO:84, a CDR2 of SEQ ID NO:87 and a CDR3 of SEQ ID NO:90; a CDR1 of SEQ ID NO:84, a CDR2 of SEQ ID NO:88 and a CDR3 of SEQ ID NO:90; a CDR1 of SEQ ID NO:85, a CDR2 of SEQ ID NO:89 and a CDR3 of SEQ ID NO:91; or a CDR1 of SEQ ID NO:86, a CDR2 of SEQ ID NO:89 and a CDR3 of SEQ ID NO: 92.

In some instances, the INS analogs have a binding affinity at an IR that is comparable to the binding affinity of native, human INS (SEQ ID NOS:3 and 4). In other instances, the INS analogs have a binding affinity at an IR that is greater than that of native, human INS (SEQ ID NOS:3 and 4). In other instances, the INS analogs have a binding affinity at an IR that is weaker than that of native, human INS (SEQ ID NOS:3 and 4).

In some instances, the INS analogs have a t½ that is longer than that of native, human INS (SEQ ID NOS:3 and 4), including up to about 20 days to about 30 days longer when administered to a human.

The compositions above alternatively can be nucleic acid sequences encoding the amino acid sequences herein, as well as vectors and host cells including the same for expressing the VHH moieties or the INS analogs herein.

Second, pharmaceutical compositions are described that include an INS analog herein or a pharmaceutically acceptable salt thereof (e.g., trifluroacetate salts, acetate salts or hydrochloride salts) and a pharmaceutically acceptable carrier. In some instances, the pharmaceutically acceptable carrier is a buffer such as, for example, physiological saline, phosphate-buffered saline, citrate-buffered saline or histidine-buffered saline. In certain instances, the buffer is histidine, a histidine buffer or a histidine-buffered saline. In other instances, the pharmaceutical compositions further can include carriers, diluents and/or excipients.

Moreover, the pharmaceutical compositions can include at least one additional therapeutic agent such as, for example, an agent used as a standard of care in a metabolic condition, disease or disorder. In some instances, the at least one additional therapeutic agent can be a dipeptidyl peptidase 4 (DPP-IV) inhibitor, a native amylin or analog thereof, a short-acting (prandial) INS analog, a native incretin or analog thereof, a native insulin-like growth factor (IGF) or analog thereof, metformin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, a statin, a sulfonylurea (SU), a thiazolidinedione (TZD), and/or other anti-glycemic agent or other anti-obesity agent.

Third, methods are described for using the INS analogs herein, especially for using the INS analogs to treat metabolic conditions, diseases or disorders. The methods include at least a step of administering to an individual in need thereof an effective amount of an INS analog or a pharmaceutically acceptable salt thereof.

In some instances, the INS analog can be administered via any standard route of administration such as, for example, intramuscularly, intravenously, parenterally, subcutaneously or transdermally. In certain instances, the INS analog is administered subcutaneously (SQ), intramuscularly (IM) or intravenously (IV). In particular instances, the INS analog can be administered SQ or IV to the individual.

Likewise, and in some instances, the INS analog can be administered daily, every other day, three times a week, two times a week, one time a week (i.e., weekly), biweekly (i.e., every other week), one time a month (i.e., monthly), bimonthly (i.e., every other month), or even every three months. In certain instances, the INS analog can be administered SQ every other day, SQ three times a week, SQ two times a week, SQ one time a week, SQ every other week, or SQ once a month. In particular instances, the INS analog is administered SQ one time a week (QW).

Alternatively, the INS analog can be IV administered to the individual. As above, the INS analog can be administered daily, every other day, three times a week, two times a week, one time a week (i.e., weekly), biweekly (i.e., every other week), or monthly. In certain instances, the INS analog can be administered IV every other day, IV three times a week, IV two times a week, IV one time a week, IV every other week, or IV once a month. In particular instances, the INS analog is administered IV one time a week.

The methods also can include a step of administering the INS analog in combination with an effective amount of at least one additional therapeutic agent. Briefly, the standard of care for many of the conditions/diseases/disorders herein includes a DPP-IV inhibitor, a native amylin or analog thereof, a short-acting (prandial) INS analog, a native incretin or analog thereof, a native IGF or analog thereof, metformin, a SGLT2 inhibitor, a statin, a SU, a TZD, and/or other anti-glycemic agent or other anti-obesity, as well as other therapeutic agents to control comorbidities, including, but not limited to, high cholesterol and high blood pressure. In some instances, the additional therapeutic agent can be administered simultaneously, separately or sequentially with the INS analog.

For example, the additional therapeutic agent can be administered with a frequency the same as the INS analog (i.e., every other day, twice a week, weekly or even monthly). In other instances, the additional therapeutic agent can be administered with a frequency distinct from the INS analog. In other instances, the additional therapeutic agent can be administered SQ or IV. In still other instances, the INS analog is administered SQ, and the additional therapeutic agent can be administered orally or IV. Alternatively, the INS analog is administered IV, and the additional therapeutic agent is administered SQ.

In some instances, the individual is a diabetic and/or obese.

The methods also may include steps such as measuring or obtaining blood glucose, HbAlc, cholesterol, triglycerides and/or body weight and comparing such measured/obtained value(s) to one or more baseline values or previously measured/obtained values to assess the effectiveness of treatment/therapy.

The methods also may be combined with diet and exercise and/or may be combined with additional therapeutic agents other than those discussed above.

Fourth, uses are described that include an INS analog herein. For example, the INS analog can be provided for use in therapy, especially in treating metabolic conditions, diseases or disorders, especially diabetes and/or obesity. The INS analog optionally can be administered simultaneously, separately or sequentially (i.e., in combination) with at least one additional therapeutic agent. Likewise, the INS analog can be provided for use in manufacturing a medicament for treating metabolic conditions, diseases or disorders, where the medicament optionally may further include one or more additional therapeutic agents as noted above.

Fifth, a compound is provided that includes an amino acid sequence of: FVNQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:37). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:37.

Alternatively, a compound is provided that includes an amino acid sequence of: FVDQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:38). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:38.

Alternatively, a compound is provided that includes an amino acid sequence of: FVNQHLCGAHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLEN YCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRL SCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNS KNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:39). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:39.

Alternatively, a compound is provided that includes an amino acid sequence of: FVNQHLCGSHLVEALELVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:40). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:40.

Alternatively, a compound is provided that includes an amino acid sequence of: FVNQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:41). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:41.

Alternatively, a compound is provided that includes an amino acid sequence of: FVNQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLYQLEN YCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRL SCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNS KNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS (SEQ ID NO:42). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:42.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:43). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:43.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:44). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:44.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:45). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:45.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:46). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:46.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:47). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:47.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:48). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:48.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:49). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:49.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:50). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:50.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALFLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:51). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:51.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALWLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:52). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:52.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:53). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:53.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:54). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:54.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:55). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:55.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:56). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:56.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:57). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:57.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:58). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:58.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:59). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:59.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:60). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:60.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:61). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:61.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:62). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:62.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:63). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:63.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:64). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:64.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:65). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:65.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:66). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:66.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGEGGEGGEGGEGGEGGEGGEGGEVQLLESGGGLVQPGGSLRLSCAASGRYI DETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYLQM NSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:67). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:67.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGEGGGGEGGGGEGGGGEGGGGEVQLLESGGGLVQPGGSLRLSCAASGR YIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYLQ MNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:68). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:68.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGKGGGGKGGGGKGGGGKGGGGEVQLLESGGGLVQPGGSLRLSCAASG RYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYL QMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:69). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:69.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGAPAPAPAPAPAPAPAPAPAPGGGGEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:70). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:70.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGEPEPEPEPEPEPEPEPEPEPGGGGEVQLLESGGGLVQPGGSLRLSCAASG RYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYL QMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:71). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:71.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGKPKPKPKPKPKPKPKPKPKPGGGGEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:72). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:72.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPEPGPEPGPEPGPEPGPEPGPEPGPEPGPQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNT LYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:73). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:73.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPKPGPKPGPKPGPKPGPKPGPKPGPKPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:74). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:74.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:75). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:75.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:76). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:76.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:77). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:77.

Alternatively, a compound is provided that includes an amino acid sequence of: FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:78). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:78.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:79). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:79.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:80). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:80.

Alternatively, a compound is provided that includes an amino acid sequence of: FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP (SEQ ID NO:81). In some instances, the compound can have an amino acid sequence having at least about 90% to about 99% sequence similarity to SEQ ID NO:81.

An advantage of the INS analogs herein is that they can be chemically or recombinantly synthesized as a single-chain polypeptide (i.e., monomeric) and thus do not require endoproteolytic processing for biological activity. It is contemplated, however, that in some instances, the VHH moiety can be conjugated not only to single-chain INS but also to two-chain INS (e.g., native) as well. On the VHH moiety, one could conjugate not only to the N- and C-terminus but also to any surface-exposed amino acid of the VHH (with the proviso that such conjugation does not entirely abrogate albumin binding by the VHH moiety or IR signaling by the INS moiety).

An advantage of the INS analogs herein is that the VHH moieties can be used not only with native A chain and B chain sequences but also with modified sequences thereof. Moreover, the VHH moieties may be further modified to have enhanced or additional functionality via other peptide/protein fusions or small molecules being attached to the VHH moieties.

An advantage of the INS analogs herein is that the VHH moieties provide an extended duration of action in mammals such as humans and can have a t½ of about 20 days to about 30 days, thereby allowing for at least weekly or biweekly administration when compared to native, human INS, especially native, human INS (SEQ ID NOS:3 and 4), which can improve compliance.

An advantage of the INS analogs herein is that they have similar or better selectivity, affinity and/or potency for an IR when compared to native, human INS (SEQ ID NOS:3 and 4).

An advantage of the INS analogs herein is that they have tunable pharmacokinetics achieved by changing albumin affinity of the VHH moieties.

An advantage of the INS analogs herein is that they have improved stability in formulation, especially in a preserved formulation, when compared to native, human INS (SEQ ID NOS:3 and 4) or INS analogs not fused with one of the VHH moieties herein.

An advantage of the VHH moieties herein is that they have similar binding not only to human serum albumin but also to dog, monkey, mouse, pig and rat serum albumin, which allows for pharmacodynamic, pharmacokinetic and toxicologic studies to more readily translate from these species to humans or among the other species listed above.

An advantage of the VHH moieties herein is that they not only can be used to improve the t½ of the INS analogs herein when compared to native, human INS (SEQ ID NOS:3 and 4) but also can be used to improve the t½ of other biologically active peptides and proteins such as, for example, growth differentiation factor 15 (GDF-15), glucose-dependent insulinotropic peptide 1 (GLP-1) or relaxin (RLN).

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of skill in the art to which the disclosure pertains. Although any methods and materials similar to or equivalent to those described herein can be used in the practice or testing of the INS analogs, pharmaceutical compositions and methods, the preferred methods and materials are described herein.

Moreover, reference to an element by the indefinite article “a” or “an” does not exclude the possibility that more than one element is present, unless the context clearly requires that there be one and only one element. The indefinite article “a” or “an” thus usually means “at least one.”

Definitions

As used herein, “about” means within a statistically meaningful range of a value or values such as, for example, a stated concentration, length, molecular weight, pH, sequence similarity, time frame, temperature, volume, etc. Such a value or range can be within an order of magnitude typically within 20%, more typically within 10%, and even more typically within 5% of a given value or range. The allowable variation encompassed by “about” will depend upon the particular system under study, and can be readily appreciated by one of skill in the art.

As used herein, and in reference to one or more receptors, “activity,” “activate,” “activating” and the like means a capacity of a compound, such as an INS analog herein, to bind to and induce a response at the receptor(s), as measured using assays known in the art, such as the in vtro assays described below.

As used herein, “amino acid” means a molecule that, from a chemical standpoint, is characterized by a presence of one or more amine groups and one or more carboxylic acid groups, and may contain other functional groups. As is known in the art, there is a set of twenty amino acids that are designated as standard amino acids and that can be used as building blocks for peptides/proteins produced by any living being. The amino acid sequences in the disclosure contain the standard single letter or three letter codes for the twenty naturally occurring amino acids.

As used herein, “analog” means a compound, such as a synthetic peptide, polypeptide or protein, that activates a target receptor and that elicits at least one in vivo or in vitro effect elicited by a native agonist for that receptor.

As used herein, “agonist” means a ligand for a receptor that binds to the receptor and activates the receptor.

As used herein, “conservative substitution” means a variant of a reference peptide, polypeptide or protein that is identical to the reference molecule, except for having one or more conservative amino acid substitutions in its amino acid sequence. In general, a conservatively modified variant includes an amino acid sequence that is at least about 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% identical to a reference amino acid sequence. More specifically, a conservative substitution refers to substitution of an amino acid with an amino acid having similar characteristics (e.g., charge, side-chain size, hydrophobicity/hydrophilicity, backbone conformation and rigidity, etc.) and having minimal impact on the biological activity of the resulting substituted peptide, polypeptide or protein. Conservative substitutions of functionally similar amino acids are well known in the art and thus need not be exhaustively described herein.

As used herein, “effective amount” means an amount or dose of one or more of the INS analogs herein, or a pharmaceutically acceptable salt thereof that, upon single or multiple dose administration to an individual in need thereof, provides a desired effect in such an individual under diagnosis or treatment (i.e., may produce a clinically measurable difference in a condition of the individual such as, for example, reduced blood glucose, reduced HbAlc, reduced cholesterol, reduced triglyceride or reduce body weight). An effective amount can be readily determined by one of skill in the art by using known techniques and by observing results obtained under analogous circumstances. In determining the effective amount for an individual, a number of factors are considered, including, but not limited to, the species of mammal, its size, age and general health, the specific disease or disorder involved, the degree of or involvement or the severity of the disease or disorder, the response of the individual, the particular INS analog administered, the mode of administration, the bioavailability characteristics of the preparation administered, the dose regimen selected, the use of concomitant medication, and other relevant circumstances.

As used herein, “extended duration of action” means that binding and activity for an INS analog herein continues for a period of time greater than a native INS, especially native, human INS (SEQ ID NOS:3 and 4), allowing for dosing at least as infrequently as once daily or even thrice-weekly, twice-weekly or once-weekly. The time action profile of the INS analog may be measured using known pharmacokinetic test methods such as those utilized in the Examples below.

As used herein, “half-life” or “t½” means a time it takes for one-half of a quantity of a compound, such as native INS or an INS analog herein, to be removed from a fluid or other physiological space such as serum or plasma of an individual by biological processes. Alternatively, t½ also can mean a time it takes for a quantity of such a compound to lose one-half of its pharmacological, physiological or radiological activity.

As used herein, “half-maximal effective concentration” or “EC₅₀” means a concentration of compound that results in 50% activation/stimulation of an assay endpoint, such as a dose-response curve (e.g., IRS-PI3K-Akt and IRS-Raf/Ras/MEK/MAPK signaling pathways).

As used herein, “in combination with” means administering at least one of the INS analogs herein either simultaneously, sequentially or in a single combined formulation with one or more additional therapeutic agents.

As used herein, “insulin” or “INS” means an insulin obtained or derived from any species, such as a mammalian species, especially a human, where the native form is a heterodimeric peptide having two peptide chains (e.g., an A chain and a B chain) connected via two disulfide bonds, and with the A chain further having a single intramolecular disulfide bond. In humans, INS processing begins with preproinsulin (SEQ ID NO:1; see also, UniProt/SwissProt Database Accession No. P01308), which is processed to proinsulin (includes A chain, B chain and C peptide; native INS has a structure of B-C-A), where the sequence of native, human proinsulin is set forth in SEQ ID NO:2. Proinsulin undergoes further processing in which the C peptide is cleaved to arrive at INS. The sequence for the A chain of native, human INS is set forth in SEQ ID NO:3. Likewise, the sequence for the B chain of native, human INS is set forth in SEQ ID NO:4.

INS signaling occurs through the IR, which is a homodimer of two α chains and two β (αβ)₂ chains that possess tyrosine kinase activity. The IR has been found, for example, in adipose tissue, brain, erythrocytes, fibroblasts, granulocytes, heart, kidney, monocytes, pulmonary alveoli, pancreatic acini, placenta, vascular endothelium and skeletal muscle. In humans, there are two IR isoforms—IR-A (SEQ ID NO:5; see also, UniProt/SwissProt Database Accession No. P06213) and IR-B (SEQ ID NO:6; see also, UniProt/SwissProt Database Accession No. P06213). Moreover, there are known differences in tissue expression, ligand binding affinity, receptor internalization, recycling time and intracellular signaling between IR-A and IR-B. See, e.g., Belfiore et al. (2009) Endocr. Rev. 30:586-6923; Benyoucef (2007) Biochem. J. 403:603-613; Frasca (1999) Mol. Cell. Biol. 19:3278-3288; Seino et al. (1989) Proc. Natl. Acad. Sci. USA 86:114-118; and Yamaguchi et al. (1993) Endocrinology 132:1132-1138. Stimulating the IR activates signal transduction networks involving tyrosine kinase, PI3K or Ras.

As used herein, “insulin analog” or “INS analog” and the like means a compound, such as a peptide or polypeptide, that elicits one or more effects of native INS at an IR but varies in some manner with respect to the amino acid sequence when compared native INS due to one or more additions, deletions, insertions and/or substitutions. INS analog also can include variants of these compounds, which are functionally equivalent to native INS but have sequences that are fragments or are the complete sequence but themselves having further additions, deletions, insertions and/or substitutions. All references to amino acid positions in unmodified or modified INS described herein are based on the corresponding position in the A chain of SEQ ID NO:3 or the B chain of SEQ ID NO:4 of native, human INS, unless otherwise specified. In some instances, the INS analogs herein can bind to the IR with higher or lower affinity but demonstrate a longer t½ in vivo or in vitro when compared to native INS, especially a native, human INS (SEQ ID NOS:3 and 4). In this manner, the INS analogs herein are synthetic compounds that act as IR agonists.

As used herein, “insulin resistance” means a physiological condition where a normal or elevated INS level produces an attenuated biological response in an individual.

As used herein, “individual in need thereof” means a mammal, such as a human, with a condition, disease, disorder or symptom requiring treatment or therapy, including for example, those listed herein. In particular, the preferred individual to be treated is a human.

As used herein, “long-acting” means that binding affinity and activity of an INS analog herein continues for a period of time greater than native, human INS (SEQ ID NOS:3 and 4), allowing for dosing at least as infrequently as once daily or even thrice-weekly, twice-weekly, once-weekly or monthly. The time action profile of the INS analogs herein may be measured using known pharmacokinetic test methods such as those described in the Examples below.

As used herein, “non-standard amino acid” means an amino acid that may occur naturally in cells but does not participate in peptide synthesis. Non-standard amino acids can be constituents of a peptide and often times are generated by modifying standard amino acids in the peptide, polypeptide or protein (i.e., via post-translational modification). Non-standard amino acids can include D-amino acids, which have an opposite absolute chirality of the standard amino acids above.

As used herein, “pharmaceutically acceptable buffer” means any of the standard pharmaceutical buffers known to one of skill in the art.

As used herein, “sequence similarity” means a quantitative property of two or more nucleic acid sequences or amino acid sequences of biological compounds such as, for example, a correspondence over an entire length or a comparison window of the two or more sequences. Sequence similarity can be measured by (1) percent identity or (2) percent similarity. Percent identity measures a percentage of residues identical between two biological compounds divided by the length of the shortest sequence; whereas percent similarity measures identities and, in addition, includes sequence gaps and residue similarity in the evaluation. Methods of and algorithms for determining sequence similarity are well known in the art and thus need not be exhaustively described herein. A specified percentage of identical nucleotide or amino acid positions is at least about 75%, 80%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or higher.

As used herein, “single-chain insulin,” “scINS,” “SCI” and the like means an INS polypeptide where the A and B chains are connected to one another by a non-native linker (i.e., L₂) as in A-L₂-B or B-L₂-A. Moreover, SCI can include at least one of the native interchain and/or intrachain disulfide bonds to maintain correct structural folding.

As used herein, “two-chain insulin,” “tcINS,” “TCI” and the like means an INS polypeptide where the A and B chains are connected to one another by one or more interchain and/or intrachain disulfide bonds, but not by any linkers, to maintain correct structural folding, such as a native INS.

As used herein, “treating” or “to treat” means managing and caring for an individual having a condition, disease, disorder or symptom for which INS analog administration is indicated for the purpose of attenuating, restraining, reversing, slowing or stopping progression or severity of the condition, disease, disorder or symptom. Treating includes administering an INS analog herein or composition containing an INS analog herein to the individual to prevent the onset of symptoms or complications, alleviating the symptoms or complications, or eliminating the condition, disease, disorder or symptom. Treating includes administering an INS analog or composition containing an INS analog herein to the individual to result in such as, for example, reduced blood glucose, reduced HbAlc, reduced cholesterol, reduced triglyceride or reduced body weight. The individual to be treated is a mammal, especially a human.

As used herein, “patient,” “subject” and “individual,” are used interchangeably herein, and mean a mammal, especially a human. In certain instances, the individual is further characterized with a condition, disease, disorder or symptom that would benefit from administering an INS analog herein.

As used herein, “VHH” or “VHH moiety” means a form of single-domain antibody, especially an antibody fragment of a single, monomeric variable region of a heavy chain only antibody (HcAb), which has a very small size of about 15 kDa. It has been found herein that VHH moieties can be used as a pharmacokinetic enhancer to extend the duration of action of and/or to improve the t½ of the INS analogs herein. The VHH moieties herein bind serum albumin, especially human serum albumin; however, the VHH moieties alternatively can be used to bind IgG (including Fc domain), neonatal Fc receptor (FcRn) or other long-lasting serum proteins. Although the VHH moieties herein are used to improve the t½ of INS, they likewise can be used to improve the t½ of other biologically active peptides/proteins such as, for example, GDF-15, GLP-1 or RLN.

Because the VHH moieties are a single-domain, heavy chain antibody, they have three CDRs, which include residues that form specific interactions with an antigen such as, for example, human serum albumin. Assigning the residues to the various CDRs may be done by algorithms such as, for example, Chothia, IMBT, Kabat or North. The North CDR definition is based on affinity propagation clustering with a large number of crystal structures (North et al. (2011) J. Mol. Bio. 406:228-256). Herein, the CDRs are best defined by the sequences listed in the Sequence Listing, which are based upon a combination of multiple definitions including North and Kabat.

In some instances, the VHH moiety at least can include a complementarity-determining region (CDR) 1 (CDR1), a CDR2 and a CDR3, where CDR1 can be one of SEQ ID NOS:84, 85 and 86, where CDR2 can be one of SEQ ID NOS:87, 88 and 89, and CDR3 can be one of SEQ ID NOS:90, 91 and 92.

Certain abbreviations are defined as follows: “ACR” refers to urine albumin/urine creatinine ratio; “amu” refers to atomic mass unit; “AUC” refers to area under the curve; “BHI” refers to biosynthetic human insulin; “Boc” refers to tert-butoxycarbonyl; “cAMP” refers to cyclic adenosine monophosphate; “CMV” refers to cytomegalovirus; “DNA” refers to deoxyribonucleic acid; “DMF” refers to dimethylformamide; “DMSO” refers to dimethyl sulfoxide; “EDC” refers to 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride; “EDTA” refers to ethylenediaminetetraacetic acid; “EIA/RIA” refers to enzyme immunoassay/radioimmunoassay; “ETA” refers to ethanolamine; “GS” refers to glutamine synthetase; “HIC” refers to hydrophobic interaction chromatography; “hr” refers to hour or hours; “HTRF” refers to homogenous time-resolved fluorescent; “IV” refers to intravenous; “kDa” refers to kilodaltons; “LC-MS” refers to liquid chromatography-mass spectrometry; “min” refers to minute or minutes; “MS” refers to mass spectrometry; “MSX” refers to methionine sulfoximine; “NHS” refers to N-hydroxysuccinimide; “OtBu” refers to O-tert-butyl; “Pbf” refers to NG-2,2,4,6,7-pentamethyldihydrobenzofuran-5-sulfonyl; “PEI” refers to polyethylenimine; “RP-HPLC” refers to reversed-phase high performance liquid chromatography; “sec” refers to second or seconds; “NaOAc” refers to sodium acetate; “RU” means resonance units; “SPA” refers to scintillation proximity assay; “SEC” refers to size-exclusion chromatography; “SEM” refers to standard error of the mean; “SPR” refers to surface plasmon resonance; “SQ” refers to subcutaneous; “TFA” refers to trifluoroacetic acid; and “Trt” refers to trityl.

Insulin Analogs

The INS analogs herein have structural similarities to, but many structural differences, from native, human INS (SEQ ID NOS:3 and 4). For example, when compared to native, human INS (SEQ ID NOS:3 and 4), the INS analogs herein include at least one variation when compared to the amino acids present in native, human INS, include a peptide linker between the A chain and the B chain, and include a pharmacokinetic enhancer such as an albumin-binding VHH moiety. The INS analogs herein result in sufficient activity at an IR and therefore have beneficial attributes relevant to their developability as therapeutic treatments, including improved solubility in aqueous solutions, improved chemical and physical formulation stability, extended pharmacokinetic profile (which can be tuned based upon VHH affinity to serum albumin), and minimized potential for immunogenicity.

Briefly, the INS analogs herein include an amino acid sequence from the amino-terminus to the carboxy-terminus having one of the following structures:

VHH-L₁-A-L₂-B,

VHH-L₁-B-L₂-A,

A-L₂-B-L₁-VHH, or

B-L₂-A-L₁-VHH,

where VHH is a moiety acting as a pharmacokinetic enhancer, A is an INS A chain, B is an INS B chain, L₁ is a first peptide linker and L₂ is a second peptide linker, where L₁ and L₂ are distinct from one another (i.e., each have an amino acid sequence that is not the same). In some instances, the INS analogs have an amino acid sequence from the amino-terminus to the carboxy-terminus of B-L₂-A-L₁-VHH.

With regard to the A chain, it can be a native INS A chain, such as a native, human INS A chain (SEQ ID NO:3). Alternatively, the A chain can be a variant thereof. For example, the A chain variant can have an amino acid sequence that includes a E4Q mutation, a T8H mutation, a Y14E mutation, a N21G mutation or a combination thereof (e.g., T8H and N21G; or T8H, Y14E and N21G) when compared to SEQ ID NO:3. Alternatively, the A chain can be a truncation thereof. For example, the A chain may be an INS A chain lacking residues 1 to 3 (desA1-3) or lacking residue 21 (desA21) of SEQ ID NO:3.

Likewise, and with regard to the B chain, it can be a native INS chain, such as a native, human INS B chain (SEQ ID NO:4). Alternatively, the B chain can be a variant thereof. For example, the B chain variant can have an amino acid sequence that includes a N3D mutation, a N3K mutation, a N3S mutation, a S9A mutation, a Y16E mutation, a Y16F mutation, a Y16H mutation, a Y16R mutation, a Y16W mutation, a E21Q mutation, a F25H mutation or a combination thereof (e.g., N3S and Y16F; N3S and Y16H; N3S and Y16R; N3S and Y16W; N3S and F25H; N3S and Y16R; N3S, Y16H and F25H; or N3S, Y16R and F25H) of SEQ ID NO:4. Alternatively, the B chain can be a truncation thereof. For example, the B chain may be an INS B chain lacking residues 1 to 3 (desB1-3) or lacking residues to 27 to 30 (desB27-30) of SEQ ID NO:4.

In view of the above, the A chain can be a native, human INS A chain (SEQ ID NO:3) and the B chain can be a native, human INS B chain (SEQ ID NO:4). In other instances, the A chain can be a variant of SEQ ID NO:3 and the B chain can be SEQ ID NO:4. Alternatively, the A chain can be SEQ ID NO:3 and the B chain can be a variant of SEQ ID NO:4. Alternatively still, the A chain can be a variant of SEQ ID NO:3 and the B chain can be a variant of SEQ ID NO:4. In yet other instances, the A chain can be a truncation of SEQ ID NO:3 and the B chain can be SEQ ID NO:4. Alternatively, the A chain can be a truncation of SEQ ID NO:3 and the B chain can be a variant of SEQ ID NO:4 or a truncation of SEQ ID NO:4. In yet other instances, the A chain can be SEQ ID NO:3 and the B chain can be a truncation of SEQ ID NO:4. Alternatively, the A chain can be a variant of SEQ ID NO:3 or a truncation of SEQ ID NO:3 and the B chain can be a truncation of SEQ ID NO:4.

Other A and B chains that may be used in the INS analogs herein are described in, for example, Intl. Patent Application Publication Nos. WO 1996/034882, WO 2005/054291, WO 2006/097521, WO 2007/096332, WO 2007/104734, WO 2007/104736, WO 2007/104737, WO 2007/104738, WO 2011/031622, WO 2011/159895, WO 2014/071405, WO 2016/057529, WO 2017/052305, WO 2018/165290, WO 2018/217573 and WO 2019/066570; see also, Glidden et al. (2018) J. Biol. Chem. 293:47-68; Hua et al. (2008) J. Biol. Chem. 283:14703-14716; Kaur et al. (2013) ACS Chem. Biol. 8:1822-1829; Mao et al. (2017) Appl. Microbiol. Biotechnol. 101:3259-3271; Mao et al. (2019) Appl. Microbiol. Biotechnol. 103:1-15; Sanlioglu et al. (2013) Islets 5:67-78.

With regard to L₁, it can be a peptide of about 1 to about 50 amino acids. Alternatively, L₁ can be from about 1, about 5, about 10, about 15, about 20, about 25, about 30, about 35, about 40, about 45 or about 50 amino acids. Alternatively still, L₁ can be from about 5 to about 10 amino acids, from about 10 to about 15 amino acids, from about 15 to about 20 amino acids, from about 20 to about 25 amino acids, from about 25 to about 30 amino acids, from about 30 to about 35 amino acids, from about 35 to about 40 amino acids, from about 40 to about 45 amino acids, or from about 45 to about 50 amino acids. In some instances, L₁ may be omitted such that the A chain or B chain is directly conjugated to the VHH moiety. In some instances, L₁ can include a repeating sequence of (GGGGQ)_(n)(SEQ ID NO:10), where n can be from about 1 to about 10, especially 5 (i.e., (GGGGQ)₅; SEQ ID NO:23). In other instances, L₁ can include a repeating sequence of (PGPQ)_(n) (SEQ ID NO:13), where n can be from about 1 to about 10, especially 8 (i.e., (PGPQ)₈; SEQ ID NO:24). In still other instances, L₁ can include a repeating sequence of (PGPA)_(n) (SEQ ID NO:14), where n can be from about 1 to about 10, especially 8 (i.e., (PGPA)₈; SEQ ID NO:25). In still other instances, L₁ can include a repeating sequence of (GGE)_(n)GG (SEQ ID NO:15), where n can be from about 1 to about 10, especially 7 (i.e., (GGE)₇GG; SEQ ID NO:26). In still other instances, L₁ can include a repeating sequence of (GGGGE)_(n)GGGG (SEQ ID NO:16), where n can be from about 1 to about 10, especially 4 (i.e., (GGGGE)₄GGGG; SEQ ID NO:27). In still other instances, L₁ can include a repeating sequence of (GGGGK)_(n)GGGG (SEQ ID NO:17), where n can be from about 1 to about 10, especially 4 (i.e., (GGGGK)₄GGGG; SEQ ID NO:28). In still other instances, L₁ can include a repeating sequence of GGGG(AP)_(n)GGGG (SEQ ID NO:18), where n can be from about 1 to about 10, especially 10 (i.e., GGGG(AP)₁₀GGGG; SEQ ID NO:29). In still other instances, L₁ can include a repeating sequence of GGGG(EP)_(n)GGGG (SEQ ID NO:19), wherein n can be from about 1 to about 10, especially 10 (i.e., GGGG(EP)₁₀GGGG; SEQ ID NO:30). In still other instances, L₁ can include a repeating sequence of GGGG(KP)_(n)GGGG (SEQ ID NO:20), where n can be from about 1 to about 10, especially 10 (i.e., GGGG(KP)₁₀GGGG; SEQ ID NO:31). In still other instances, L₁ can include a repeating sequence of (PGPE)_(n)PGPQ (SEQ ID NO:21), where n can be from about 1 to about 10, especially 7 (i.e., (PGPE)₇PGPQ; SEQ ID NO:32). In still other instances, L₁ can include a repeating sequence of (PGPK)_(n)PGPQ (SEQ ID NO:22), where n can be from about 1 to about 10, especially 7 (i.e., (PGPK)₇PGPQ; SEQ ID NO:33).

Other linkers that could be used in the INS analogs as L₁ include, but are not limited to, (GGGQ)_(n) (SEQ ID NO:11) or (GGGGS)_(n)(SEQ ID NO:12).

With regard to L₂, it can be a peptide of about 1 to about 15 amino acids. Alternatively, L₂ can be about 1, about 2, about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, about 12, about 13, about 14, or about 15 amino acids. Alternatively still, L₂ can be about 1 to about 5 amino acids, about 5 to about 10 amino acids, about 10 to about 15 amino acids, especially 10 to 15 amino acids. In some instances, L₂ can include a mix of Ala/A, Gln/Q, Gly/G, Pro/P and Ser/S residues. In other instances, L₂ can be SEQ ID NO:34, 35 or 36.

With regard to VHH, it can be a polypeptide of about 50 to about 200 amino acids, especially about 125 of about 150 amino acids that can bind serum albumin or another serum protein having a long t½. In some instances, VHH can be any one of SEQ ID NOS:7, 8 or 9. The structural features of these VHH moieties result in INS analogs having a longer t½ when compared to native INS, especially native, human INS (SEQ ID NOS:3 and 4). Given that the VHH moieties herein target serum albumin, the t½ of the INS analogs herein therefore can be expected to be similar to that of serum albumin of the species to which the INS analog is administered (taking into account any target-mediated drug disposition).

In addition to the changes described herein, the INS analogs may include one or more additional amino acid modifications, especially conservative substitutions, provided, however, that the INS analogs remain capable of binding to and activating the IR.

Taken together, exemplary INS analogs are as follows:

INS Analog 1, which includes from N-terminus to C-terminus a B chain of INS, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 37) FVNQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS;

INS Analog 2, which includes from N-terminus to C-terminus a B chain of INS having a N3D mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 38) FVDQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDAN LYDYWGQGTLVTVSS;

INS Analog 3, which includes from N-terminus to C-terminus a B chain of INS having a S9A mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 39) FVNQHLCGAHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDAN LYDYWGQGTLVTVSS;

INS Analog 4, which includes from N-terminus to C-terminus a B chain of INS having a Y16E mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 40) FVNQHLCGSHLVEALELVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL SVQPGGSLRLCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDAN LYDYWGQGTLVTVSS;

INS Analog 5, which includes from N-terminus to C-terminus a B chain of INS having a Y16H mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 41) FVNQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDAN LYDYWGQGTLVTVSS;

INS Analog 6, which includes from N-terminus to C-terminus a B chain of INS having a F25H mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 42) FVNQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL SVQPGGSLRLCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDAN LYDYWGQGTLVTVSS;

INS Analog 7, which includes from N-terminus to C-terminus a B chain of INS having a N3S mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acids sequence:

(SEQ ID NO: 43) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY YQLENCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 8, which includes from N-terminus to C-terminus a B chain of INS having N3S and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 44) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 9, which includes from N-terminus to C-terminus a B chain of INS having N3S and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 45) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 10, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16H mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 46) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 11, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H, Y14E and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 47) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLE QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 12, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 48) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 13, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H, Y14E and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 49) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLE QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 14, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 50) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY CQLENYGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA ADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVA DLYPYWGQGTLVTVSSPP;

INS Analog 15, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16F mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 51) FVSQHLCGSHLVEALFLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 16, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16W mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 52) FVSQHLCGSHLVEALWLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLY QLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA EVQLLESGGGL VQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYA DSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 17, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 53) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGPGPAPGPAPGPAP GPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 18, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPA)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 54) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGPGPAPGPAPGPAP GPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 19, which includes from N-terminus to C-terminus a B chain of INS having a N3S mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 55) VSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGG GIVEQCCTSICSLYQLENYCGGGGGQGGGGQGGGG QGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITY YADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVY YCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 20, which includes from N-terminus to C-terminus a B chain of INS having a N3S mutation, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 56) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGG GGTVEQCCTSICSLYQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 21, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G4Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 57) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGGGGGQGGGGQGGG GQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAV YYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 22, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 58) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 23, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having Y14E and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 59) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLEQLENYCGGGGGQGGGGQGGG GQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAV YYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 24, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16H and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having Y14E and N21G mutations, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 60) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLEQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 25, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 61) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGG GGIVEQCCTSICSLYQLENYCGGGGGQGGGGQGGG GQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAV YYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 26, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having a N21G mutation, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 62) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGG GGIVEQCCTSICSLYQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 27, which includes from N-terminus to C-terminus a B chain having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 63) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGGGGGQGGGGQGGG GQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAV YYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 28, which includes from N-terminus to C-terminus a B chain of INS having N3S and Y16R mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 64) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 29, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 65) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGGGGGQGGGGQGGG GQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAV YYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP;

INS Analog 30, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPQ)₈ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 66) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGPGPQPGPQPGPQP GPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGI GGGVDITYYADSVKGRFTISRDNSKNTLYLQMNSL RPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTL VTVSSPP;

INS Analog 31, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₂E)₇G₂ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 67) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGG GGIVEQCCHSICSLYQLENYCGGGEGGEGGEGGEG GEGGEGGEGGEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYY ADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYY CAARPGRPLITSKVADLYPYWGQGTLVTVSSPP ;

INS Analog 32, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄E)₄G₄ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 68) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGEGGGGEGGGGEGGGGEGGGG EVQLLESGGGLVQPGGS LRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKG RFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPY WGQGTLVTVSSPP;

INS Analog 33, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄K)₄G₄ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 69) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGKGGGGKGGGGKGGGGKGGGG EVQLLESGGGLVQPGGS LRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKG RFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPY WGQGTLVTVSSPP;

INS Analog 34, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a G₄(AP)₁₀G₄ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 70) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGAPAPAPAPAPAPAPAPAPAPGGGG EVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 35, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a G₄(EP)₁₀G₄ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 71) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGEPEPEPEPEPEPEPEPEPEPGGGG EVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 36, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a G₄(KP)₁₀G₄ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 72) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGKPKPKPKPKPKPKPKPKPKPGGGG EVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP;

INS Analog 37, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPE)₇PGPQ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 73) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPEPGPEPGPEPGPEPGPEPGPEPGPEPGPQ EVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP;

INS Analog 38, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (PGPK)₇PGPQ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 74) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPKPGPKPGPKPGPKPGPKPGPKPGPKPGPQ EVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP;

INS Analog 39, which includes from N-terminus to C-terminus a B chain of INS having N3K, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 75) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP;

INS Analog 40, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R, E21Q and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 76) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP;

INS Analog 41, which includes from N-terminus to C-terminus a B chain of INS having N3K, Y16R, E21Q and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 77) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP GRFTISRDNSKNTL;

INS Analog 42, which includes from N-terminus to C-terminus a B chain of INS having N3S, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 78) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP;

INS Analog 43 which includes from N-terminus to C-terminus a B chain of INS having N3K, Y16R and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 79) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP;

INS Analog 44 which includes from N-terminus to C-terminus a B chain of INS having N3K, Y16R, E21Q and F25H mutations, a L₂ of six residues (bolded), an A chain of INS having T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 80) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP; and

INS Analog 45 which includes from N-terminus to C-terminus a B chain of INS having N3K, Y16R and F25Q mutations, a L₂ of six residues (bolded), an A chain of INS having E4Q, T8H and N21G mutations, a (G₄Q)₅ L₁ (italicized) and a VHH moiety (underlined), has the following amino acid sequence:

(SEQ ID NO: 81) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQ EVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Half-life of the INS analogs herein may be measured using methods known in the art including, for example, those described in the Examples below. Likewise, affinity of the INS analogs herein for albumins of different species may be measured using methods known in the art for measuring binding affinities, for example, those described in the Examples below, and is commonly expressed as the equilibrium dissociation constant (K_(D)) value. Moreover, activity of the INS analogs herein at an IR or an insulin-like growth factor 1 receptor (IGF-1R) may be measured using methods known in the art, including, for example, the in vitro activity assays described below, and is commonly expressed as an EC₅₀ value.

As a result of the modifications described above, the INS analogs herein have a t2 that is longer than that of a native INS, especially native, human INS (SEQ ID NOS:3 and 4) when administered to a mammal, especially a human. As noted above, the VHH moieties herein target serum album; therefore, the t½ of the INS analogs herein can be expected to be similar to that of serum albumin of the species to which the INS analog is administered. In some instances, the INS analogs can have a t½ of about 1 day to about 31 days, of about 5 days to about 25 days, of about 10 days to about 20 days, or even of about 15 days. In other instances, the INS analogs can have a t½ of about 1 to about 5 days, of about 6 to about 10 days, of about 11 to about 15 days, of about 16 to about 20 days, of about 21 to about 25 days, or even of about 26 to about 31 days when administered to a human. In other instances, the INS analogs can have a t½ of about 1 day, about 2 days, about 3 days, about 4 days, about 5 days, about 6 days, about 7 days, about 8 days, about 9 days, about 10 days, about 11 days, about 12 days, about 13 days, about 14 days, about 15 days, about 16 days, about 17 days, about 18 days, about 19 days, about 20 days, about 21 days, about 22 days, about 23 days, about 24 days, about 25 days, about 26 days, about 27 days, about 28 days, about 29 days, about 30 days, or even about 31 days or more. In particular instances, the INS analogs can have a t½ of about 20 days when administered to a human.

Likewise, in some instances, the INS analogs herein have a potency at an IR (such as native, human IR-A or human IR-B; SEQ ID NOS:5 and 6, respectively) that is within about 10-fold to about 1000-fold of, for example, native, human INS (SEQ ID NOS:3 and 4) when administered to a human. In other instances, the INS analogs herein have a potency at an IR (such as native, human IR-A or human IR-B; SEQ ID NOS:5 and 6, respectively) that is within about 25-fold to about 975-fold, about 50-fold to about 950-fold, about 75-fold to about 925-fold, about 100-fold to about 900-fold, about 125-fold to about 875-fold, 150-fold to about 850-fold, about 175-fold to about 825-fold, about 200-fold to about 800-fold, about 225-fold to about 775-fold, about 250-fold to about 750-fold, about 275-fold to about 725-fold, about 300-fold to about 700-fold, about 325-fold to about 675-fold, about 350-fold to about 650-fold, about 375-fold to about 625-fold, about 375-fold to about 600-fold, about 400-fold to about 575-fold, about 425-fold to about 550-fold, about 450-fold to about 500-fold or about 475-fold of, for example, native, human INS (SEQ ID NOS:3 and 4) when administered to a human. In other instances, the INS analogs herein have a potency at an IR (such as native, human IR-A or human IR-B; SEQ ID NOS:5 and 6, respectively) that is about 10-fold, about 25-fold, about 50-fold, about 75-fold, about 100-fold, about 125-fold, about 150-fold, about 175-fold, about 200-fold, about 225-fold, about 250-fold, about 275-fold, about 300-fold, about 325-fold, about 350-fold, about 375-fold, about 400-fold, about 425-fold, about 450-fold, about 475-fold, about 500-fold, about 525-fold, about 550-fold, about 575-fold, about 600-fold, about 625-fold, about 650-fold, about 675-fold, about 700-fold, about 725-fold, about 750-fold, about 775-fold, about 800-fold, about 825-fold, about 850-fold, about 875-fold, about 900-fold, about 925-fold, about 950-fold, about 975-fold or about 1000-fold of, for example, native, human INS (SEQ ID NOS:3 and 4) when administered to a human.

Pharmaceutical Compositions and Kits

The INS analogs herein can be formulated as pharmaceutical compositions, which can be administered by parenteral routes (e.g., intravenous, intraperitoneal, intramuscular, subcutaneous or transdermal). Such pharmaceutical compositions and techniques for preparing the same are well known in the art. See, e.g., Remington, “The Science and Practice of Pharmacy” (D. B. Troy ed., 21^(st) Ed., Lippincott, Williams & Wilkins, 2006). In particular instances, the INS analogs are administered SQ or IV. Alternatively, however, the INS analogs can be formulated in forms for other pharmaceutically acceptable routes such as, for example, tablets or other solids for oral administration, time release capsules, and any other form currently used, including creams, lotions, inhalants and the like.

To improve their in vivo compatibility and effectiveness, the INS analogs herein may be reacted with any of a number of inorganic and organic acids/bases to form pharmaceutically acceptable acid/base addition salts. Pharmaceutically acceptable salts and common techniques for preparing them are well known in the art (see, e.g., Stahl et al., “Handbook of Pharmaceutical Salts: Properties, Selection and Use” (2^(nd) Revised Ed. Wiley-VCH, 2011)). Pharmaceutically acceptable salts for use herein include sodium, trifluoroacetate, hydrochloride and acetate salts.

The INS analogs herein may be administered by a physician or self-administered using an injection. It is understood the gauge size and amount of injection volume can be readily determined by one of skill in the art. However, the amount of injection volume can be ≤about 2 ml or even ≤about 1 ml, and the needle gauge can be ≥about 27 G or even ≥about 29 G. Alternatively, the INS analogs herein may be administered via a pump system.

The disclosure also provides and therefore encompasses novel intermediates and methods useful for synthesizing the INS analogs herein, or a pharmaceutically acceptable salt thereof. The intermediates and INS analogs can be prepared by a variety of techniques that are well known in the art. For example, a method using recombinant synthesis is illustrated in the Examples below. The specific steps for each of the techniques described may be combined in different ways to prepare the INS analogs herein. The reagents and starting materials are readily available to one of skill in the art.

The INS analogs herein are generally effective over a wide dosage range. Exemplary doses of the INS analogs or of pharmaceutical compositions including the same can be milligram (mg) or microgram (μg), nanogram (ng), or picogram (pg) amounts per kilogram (kg) of an individual. In this manner, a daily dose can be from about 1 μg to about 100 mg.

Here, the effective amount of the INS analog in a pharmaceutical composition can be a dose of about 0.25 mg to about 5.0 mg. One of skill in the art, however, understands that in some instances the effective amount (i.e., dose/dosage) may be below the lower limit of the aforesaid range and be more than adequate, while in other cases the effective amount may be a larger dose and may be employed with acceptable side effects.

In addition to the INS analog, the pharmaceutical composition also can include at least one additional therapeutic agent, especially a therapeutic agent typically used as the standard of care in metabolic conditions, diseases and disorders.

In this manner, a pharmaceutical composition can include an effective amount of at least one INS analog of SEQ ID NOS:37-81, a pharmaceutically acceptable carrier and optionally at least one additional therapeutic agent. For example, the pharmaceutical composition can include an effective amount of an INS analog of SEQ ID NO:37 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:38 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:39 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:40 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:41 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:42 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:43 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:44 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:45 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:46 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:47 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:48 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:49 and a pharmaceutically acceptable carrier, an effective amount of a INS analog of SEQ ID NO:50 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:51 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:52 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:53 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:54 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:55 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:56 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:57 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:58 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:59 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:60 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:61 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:62 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:63 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:64 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:65 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:66 and a pharmaceutically acceptable carrier, and effective amount of an INS analog of SEQ ID NO:67 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:68 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:69 and a pharmaceutically acceptable carrier, and effective amount of an INS analog of SEQ ID NO:70 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:71 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:72 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:73 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:74 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:75 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:76 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:77 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:78 and a pharmaceutically acceptable carrier, an effective amount of an INS analog of SEQ ID NO:79 and a pharmaceutically acceptable carrier, an effective amount of an ins analog of SEQ ID NO:80 and a pharmaceutically acceptable carrier, or an effective amount of an INS analog of SEQ ID NO:81 and a pharmaceutically acceptable carrier.

Alternatively, the INS analogs herein can be provided as part of a kit. In some instances, the kit includes a device for administering at least one INS analog or a composition including the same (and optionally at least one additional therapeutic agent) to an individual. In certain instances, the kit includes a syringe and needle for administering an INS analog or a composition including the same (and optionally at least one additional therapeutic agent). In particular instances, the INS analog or composition including the same (and optionally at least one additional therapeutic agent) is pre-formulated in aqueous solution within the syringe.

Methods of Making and Using the Insulin Analogs

The INS analogs herein can be made via any number of standard recombinant DNA methods or standard chemical peptide synthesis methods known in the art. With regard to recombinant DNA methods, one can use standard recombinant techniques to construct a polynucleotide having a nucleic acid sequence that encodes an amino acid sequence for an INS analog herein, incorporate that polynucleotide into recombinant expression vectors, and introduce the vectors into host cells, such as bacteria, yeast and mammalian cells, to produce the INS analog herein. See, e.g., Green & Sambrook, “Molecular Cloning: A Laboratory Manual” (Cold Spring Harbor Laboratory Press, 4^(th) ed. 2012).

With regard to recombinant DNA methods, the compounds herein can be prepared by producing a protein or precursor protein molecule using recombinant DNA techniques. DNA, including cDNA and synthetic DNA, may be double-stranded or single-stranded, and the coding sequences therein encoding a compound herein may vary as a result of the redundancy or degeneracy of the genetic code. Briefly, the DNA sequences encoding the compounds herein are introduced into a host cell to produce the compound or precursor thereof. The host cells can be bacterial cells such as K12 or B strains of Escherichia coli, fungal cells such as yeast cells, or mammalian cells such as Chinese hamster ovary (CHO) cells.

An appropriate host cell is transiently or stably transfected or transformed with an expression system, such as expression vectors, for producing a compound herein or a precursor thereof. Expression vectors typically are replicable in the host organisms either as episomes or as an integral part of the host chromosomal DNA. Commonly, expression vectors will contain selection markers such as, for example, tetracycline, neomycin, G418 and dihydrofolate reductase, to permit selection of those cells transformed with the desired DNA sequences.

The specific biosynthetic or synthetic steps for each of the steps described herein may be used, not used or combined in different ways to prepare the compounds herein.

With regard to chemical peptide synthesis methods, one can use standard manual or automated solid-phase synthesis procedures. For example, automated peptide synthesizers are commercially available from, for example, Applied Biosystems (Foster City, Calif.) and Protein Technologies Inc. (Tucson, Ariz.). Reagents for solid-phase synthesis are readily available from commercial sources. Solid-phase synthesizers can be used according to the manufacturer's instructions for blocking interfering groups, protecting amino acids during reaction, coupling, deprotecting and capping of unreacted amino acids. Additional details on making synthetic INS can be found in, for example, Arai et al. (2018) Comm. Chem. 1:26; Belgi et al. (2011) Immun. Endoc. & Metab. Agents in Med. Chem. 11:40-47; Hossain & Wade (2017) Acc. Chem. Res. 50:2116-2127; and Liu et al. (2016) J. Pept. Sci. 22:260-270. See also, Intl. Patent Application Publication No. WO 2011/031622.

One use of the INS analogs herein is for treating metabolic conditions, diseases and/or disorders. Exemplary conditions, diseases and disorders include, but are not limited to, metabolic syndrome, diabetes and obesity.

Another use of the INS analogs herein is for treating heart and/or kidney conditions, diseases and/or disorders. Exemplary heart and/or kidney conditions, diseases and disorders include, but are not limited to, dyslipidemia, stroke, nephropathy, and retinopathy.

The methods can include the steps described herein, and these maybe be, but not necessarily, carried out in the sequence as described. Other sequences, however, also are conceivable. Moreover, individual or multiple steps may be carried out either in parallel and/or overlapping in time and/or individually or in multiply repeated steps. Furthermore, the methods may include additional, unspecified steps.

Such methods therefore can include selecting an individual having a metabolic condition, disease or disorder or who is predisposed to the same. Alternatively, the methods can include selecting an individual having diabetes or who is predisposed to the same. Alternatively, the methods can include selecting an individual who is obese or who is predisposed to the same. In certain instances, the methods can include selecting an individual who is diabetic and obese or who is predisposed to the same.

The methods also can include administering to the individual an effective amount of at least one INS analog herein, which may be in the form of a pharmaceutical composition as also described herein. In some instances, the INS analog/pharmaceutical composition can include an additional therapeutic agents such a DPP-IV inhibitor, a native amylin or analog thereof, a short-acting (prandial) INS analog, a native incretin or analog thereof, a native IGF or analog thereof, metformin, a SGLT2 inhibitor, a statin, a SU, a TZD, and/or other anti-glycemic agent or other anti-obesity, as well as other therapeutic agents to control comorbidities, including, but not limited to, high cholesterol, high triglyceride, high blood pressure, atrial fibrillation and diabetes.

The concentration/dose/dosage of the INS analog and optional additional therapeutic agent are discussed elsewhere herein.

With regard to a route of administration, the INS analog or pharmaceutical composition including the same can be administered in accord with known methods such as, for example, orally; by injection (i.e., intra-arterially, intravenously, intraperitoneally, intracerebrally, intracerebroventricularly, intramuscularly, intraocularly, intraportally or intralesionally); by sustained release systems, or by implantation devices. In certain instances, the INS analog or pharmaceutical composition including the same can be administered SQ by bolus injection or continuously.

With regard to a dosing frequency, the INS analog or pharmaceutical composition including the same can be administered daily, every other day, three times a week, two times a week, one time a week (i.e., weekly), biweekly (i.e., every other week), or monthly. In certain instances, the INS analog or pharmaceutical composition including the same is administered SQ every other day, SQ three times a week, SQ two times a week, SQ one time a week, SQ every other week or SQ monthly. In particular instances, the INS analog or pharmaceutical composition including the same is administered SQ one time a week (QW).

With regard to those instances in which the INS analog or pharmaceutical composition including the same is administered in combination with an effective amount of at least one additional therapeutic agent. The additional therapeutic agent can be administered simultaneously, separately or sequentially with the INS analog or pharmaceutical composition including the same.

Moreover, the additional therapeutic agent can be administered with a frequency the same as the INS analog or pharmaceutical composition including the same (i.e., every other day, twice a week, or even weekly). Alternatively, the additional therapeutic agent can be administered with a frequency distinct from the INS analog or pharmaceutical composition including the same. In other instances, the additional therapeutic agent can be administered SQ. In other instances, the additional therapeutic agent can be administered IV. In still other instances, the additional therapeutic agent can be administered orally.

It is further contemplated that the methods may be combined with diet and exercise and/or may be combined with additional therapeutic agents other than those discussed above.

EXAMPLES

The following non-limiting examples are offered for purposes of illustration, not limitation.

Polypeptide Expression

Example 1: Recombinant Expression of INS Analog 1

Example 1 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 37) FVNQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, the INS analog of SEQ ID NO:37 is generated in a mammalian cell expression system using CHOK1 cell derivatives. A cDNA sequence encoding SEQ ID NO:37 is sub-cloned into GS-containing expression plasmid backbone (pEE12.4-based plasmids). The cDNA sequence is fused in frame with the coding sequence of a signal peptide sequence, METDTLLLWVLLLWVPGSTG (SEQ ID NO:82) to enhance secretion of the INS analog into the tissue culture medium. The expression is driven by the viral CMV promoter.

For generating the INS analog via transient transfection, CHOK1 cells are transfected with the recombinant expression plasmid using a PEI-based method. Briefly, the appropriate volume of CHOK1 suspension cells at a density of 4×10⁶ cells/ml is transferred in shake flasks, and both PEI and recombinant plasmid DNA are added to the cells. Cells are incubated in a suspension culture at 32° C. for 6 days. At the end of the incubation period, cells are removed by low speed centrifugation, and the INS analog is purified from the conditioned medium.

Alternatively, and for generating the INS analog via stable transfections, CHOK1 cells are stably transfected using electroporation and the appropriate amount of recombinant expression plasmid, and the transfected cells are maintained in suspension culture at an adequate cell density. Selection of the transfected cells is accomplished by growth in 25 μM MSX-containing serum-free medium and incubated at 35° C.-37° C. and 5%-7% CO₂.

The INS analog secreted into the media from the CHO cells is purified by Protein A affinity chromatography followed by ion exchange, hydrophobic interaction, or size-exclusion chromatography. Specifically, the INS analog from harvested media is captured onto Mab Select Protein A resin (GE). The resin then is briefly washed with a running buffer, such as a phosphate-buffered saline (PBS; pH 7.4) or a running buffer containing Tris, to remove non-specifically bound material. The protein is eluted from the resin with a low pH solution, such as 10 mM citric acid, 150 mM NaCl pH 3. Fractions containing the INS analog are pooled then diluted 1:1 with 20 mM NaOAc pH 5. The final pH is adjusted to pH 5 using 1 M NaOH and the solution may be held at a low pH to inactivate potential viruses. The pH may be neutralized by adding a base such as 0.1 M Tris pH 8.0 for subsequent size-exclusion chromatography. The INS analog may be further purified by ion exchange chromatography using resins such as POROS 50 HS (ThermoFisher). The INS analog is eluted from the column using a 0 mM to 500 mM NaCl gradient in 20 mM NaOAc, pH 5.0 over 15 column volumes.

The INS analog may be further purified by hydrophobic interaction chromatography by using a Capto Phenyl ImpRes HIC Column (GE Healthcare). The purification is performed by adjusting the column charge solution to around 0.5 M Na₂SO₄ and eluting using a 10 column volume (CV) gradient going from 0.5 M to 0 M Na₂SO₄ in a 20 mM Tris pH 8 solution. After HIC, the INS analog may be even further purified by SEC by loading the concentrated Capto Phenyl ImpRes pool on a Superdex200 (GE Healthcare) with isocratic elution in PBS pH 7.4 or in 20 mM histidine, 50 mM NaCl pH 6.0.

Purified INS analog may be passed through a viral retention filter such as Planova 20N (Asahi Kasei Medical) followed by concentration/diafiltration into 20 mM histidine, 20 mM NaCl pH 6 using tangential flow ultrafiltration on a regenerated cellulose membrane (Millipore).

The INS analog therefore is prepared in this manner or in a similar manner that would be readily determined by one of skill in the art.

Example 2: Recombinant Expression of INS Analog 2

Example 2 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 38) FVDQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, Example 2 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:38 is used in the expression plasmid.

Example 3: Recombinant Expression of INS Analog 3

Example 3 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 39) FVNQHLCGAHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, Example 3 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:39 is used in the expression plasmid.

Example 4: Recombinant Expression of INS Analog 4

Example 4 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 40) FVNQHLCGSHLVEALELVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, Example 4 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:40 is used in the expression plasmid.

Example 5: Recombinant Expression of INS Analog 5

Example 5 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 41) FVNQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, Example 5 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:41 is used in the expression plasmid.

Example 6: Recombinant Expression of INS Analog 6

Example 6 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 42) FVNQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITS RDANLYDYWGQGTLVTVSS.

Here, Example 6 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:42 is used in the expression plasmid.

Example 7: Recombinant Expression of INS Analog 7

Example 7 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 43) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 7 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:43 is used in the expression plasmid.

Example 8: Recombinant Expression of INS Analog 8

Example 8 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 44) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 8 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:44 is used in the expression plasmid.

Example 9: Recombinant Expression of INS Analog 9

Example 9 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 45) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 9 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:45 is used in the expression plasmid.

Example 10: Recombinant Expression of INS Analog 10

Example 10 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 46) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 10 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:46 is used in the expression plasmid.

Example 11: Recombinant Expression of INS Analog 11

Example 11 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 47) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSL EQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 11 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:47 is used in the expression plasmid.

Example 12: Recombinant Expression of INS Analog 12

Example 12 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 48) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 12 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:48 is used in the expression plasmid.

Example 13: Recombinant Expression of INS Analog 13

Example 13 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 49) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL EQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 13 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:49 is used in the expression plasmid.

Example 14: Recombinant Expression of INS Analog 14

Example 14 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 50) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 14 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:50 is used in the expression plasmid.

Example 15: Recombinant Expression of INS Analog 15

Example 15 is an INS analog having an amino sequence of:

(SEQ ID NO: 51) FVSQHLCGSHLVEALFLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 15 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:51 is used in the expression plasmid.

Example 16: Recombinant Expression of INS Analog 16

Example 16 is an INS analog having an amino sequence of:

(SEQ ID NO: 52) FVSQHLCGSHLVEALWLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 16 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:52 is used in the expression plasmid.

Example 17: Recombinant Expression of INS Analog 17

Example 17 is an INS analog having an amino sequence of:

(SEQ ID NO: 53) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 17 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:53 is used in the expression plasmid.

Example 18: Recombinant Expression of INS Analog 18

Example 18 is an INS analog having an amino sequence of:

(SEQ ID NO: 54) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 18 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:54 is used in the expression plasmid.

Example 19: Recombinant Expression of INS Analog 19

Example 19 is an INS analog having an amino sequence of:

(SEQ ID NO: 55) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 19 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:55 is used in the expression plasmid.

Example 20: Recombinant Expression of INS Analog 20

Example 20 is an INS analog having an amino sequence of:

(SEQ ID NO: 56) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 20 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:56 is used in the expression plasmid.

Example 21: Recombinant Expression of INS Analog 21

Example 21 is an INS analog having an amino sequence of:

(SEQ ID NO: 57) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 21 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:57 is used in the expression plasmid.

Example 22: Recombinant Expression of INS Analog 22

Example 22 is an INS analog having an amino sequence of:

(SEQ ID NO: 58) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 22 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:58 is used in the expression plasmid.

Example 23: Recombinant Expression of INS Analog 23

Example 23 is an INS analog having an amino sequence of:

(SEQ ID NO: 59) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL EQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 23 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:59 is used in the expression plasmid.

Example 24: Recombinant Expression of INS Analog 24

Example 24 is an INS analog having an amino sequence of:

(SEQ ID NO: 60) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL EQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 24 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:60 is used in the expression plasmid.

Example 25: Recombinant Expression of INS Analog 25

Example 25 is an INS analog having an amino sequence of:

(SEQ ID NO: 61) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 25 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:61 is used in the expression plasmid.

Example 26: Recombinant Expression of INS Analog 26

Example 26 is an INS analog having an amino sequence of:

(SEQ ID NO: 62) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSL YQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 26 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:62 is used in the expression plasmid.

Example 27: Recombinant Expression of INS Analog 27

Example 27 is an INS analog having an amino sequence of:

(SEQ ID NO: 63) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP

Here, Example 27 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:63 is used in the expression plasmid.

Example 28: Recombinant Expression of INS Analog 28

Example 28 is an INS analog having an amino sequence of:

(SEQ ID NO: 64) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 28 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:64 is used in the expression plasmid.

Example 29: Recombinant Expression of INS Analog 29

Example 29 is an INS analog having an amino sequence of:

(SEQ ID NO: 65) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 29 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:65 is used in the expression plasmid.

Example 30: Recombinant Expression of INS Analog 30

Example 30 is an INS analog having an amino sequence of:

(SEQ ID NO: 66) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 30 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:66 is used in the expression plasmid.

Example 31: Recombinant Expression of INS Analog 31

Example 31 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 67) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGEGGEGGEGGEGGEGGEGGEGGEVQLLESGGGLVQPGGSL RLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGR FTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYW GQGTLVTVSSPP.

Here, Example 31 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:67 is used in the expression plasmid.

Example 32: Recombinant Expression of INS Analog 32

Example 32 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 68) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGEGGGGEGGGGEGGGGEGGGGEVQLLESGGGLVQPGGS LRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKG RFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPY WGQGTLVTVSSPP.

Here, Example 32 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:68 is used in the expression plasmid.

Example 33: Recombinant Expression of INS Analog 33

Example 33 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 69) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGKGGGGKGGGGKGGGGKGGGGEVQLLESGGGLVQPGGS LRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKG RFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPY WGQGTLVTVSSPP.

Here, Example 33 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:69 is used in the expression plasmid.

Example 34: Recombinant Expression of INS Analog 34

Example 34 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 70) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGAPAPAPAPAPAPAPAPAPAPGGGGEVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP.

Here, Example 34 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:70 is used in the expression plasmid.

Example 35: Recombinant Expression of INS Analog 35

Example 35 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 71) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGEPEPEPEPEPEPEPEPEPEPGGGGEVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP.

Here, Example 35 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:71 is used in the expression plasmid.

Example 36: Recombinant Expression of INS Analog 36

Example 36 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 72) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGKPKPKPKPKPKPKPKPKPKPGGGGEVQLLESGGGLVQ PGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYAD SVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVAD LYPYWGQGTLVTVSSPP.

Here, Example 36 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:72 is used in the expression plasmid.

Example 37: Recombinant Expression of INS Analog 37

Example 37 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 73) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPEPGPEPGPEPGPEPGPEPGPEPGPEPGPQEVQLLESGG GLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDIT YYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITS KVADLYPYWGQGTLVTVSSPP.

Here, Example 37 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:73 is used in the expression plasmid.

Example 38: Recombinant Expression of INS Analog 38

Example 38 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 74) SFVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGPGPKPGPKPGPKPGPKPGPKPGPKPGPKPGPQEVQLLESGGG LVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYY ADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVA DLYPYWGQGTLVTVSSPP.

Here, Example 38 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:74 is used in the expression plasmid.

Example 39: Recombinant Expression of INS Analog 39

Example 39 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 75) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 39 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:75 is used in the expression plasmid.

Example 40: Recombinant Expression of INS Analog 40

Example 40 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 76) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 40 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:76 is used in the expression plasmid.

Example 41: Recombinant Expression of INS Analog 41

Example 41 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 77) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 41 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:77 is used in the expression plasmid.

Example 42: Recombinant Expression of INS Analog 42

Example 42 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 78) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 42 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:78 is used in the expression plasmid.

Example 43: Recombinant Expression of INS Analog 43

Example 43 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 79) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 43 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:79 is used in the expression plasmid.

Example 44: Recombinant Expression of INS Analog 44

Example 44 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 80) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 44 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:80 is used in the expression plasmid.

Example 45: Recombinant Expression of INS Analog 45

Example 45 is an INS analog having an amino acid sequence of:

(SEQ ID NO: 81) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSL YQLENYCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGG SLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVK GRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYP YWGQGTLVTVSSPP.

Here, Example 45 is generated essentially as described for Example 1 except that a cDNA sequence encoding SEQ ID NO:81 is used in the expression plasmid.

In Vitro Function

Example 46: INS Analog Albumin-Binding Studies Via SPR

In vitro binding of various INS analogs to human, cynomolgus monkey, mouse, rat, pig, dog, cow and rabbit serum albumin is determined by SPR. In particular, the affinity of Examples 23 to 30 to serum albumin of these species is summarized below in Tables 1-8.

Binding of the INS analogs of Examples 23 to 30 to various serum albumins is carried out on Biacore 8K instrument. Immobilization of serum albumin to a Series S Sensor Chip CM5 surface is performed according to the manufacturer's instructions (Amine Coupling Kit BR-1000-50). Briefly, carboxyl groups on the sensor chip surfaces (flow cell 1 and 2) are activated by injecting 70 μL of a mixture containing 75 mg/ml EDC and 11.5 mg/ml NHS at 10 μL/min. Human, cynomolgus monkey, mouse, rat, pig, dog, cow and rabbit serum albumin are diluted in 10 mM NaOAc pH 4.0 (BR-1003-49) at 1, 1, 3, 1, 1, 1, 1 and 1 μg/mL and then injected over the activated chip surfaces (flow cell 2, channel 1 to 7) at 10 μL/min for 90 sec (human, mouse, rat, pig and cow serum albumin are obtained from Sigma Aldrich (St. Louis, Mo.); cynomolgus monkey serum albumin is obtained from Holzel Diagnostika (Cologne, Germany); dog serum albumin is obtained from Molecular Innovations (Novi, Mich.); and rabbit serum albumin is obtained from Fitzgerald Industries International (Acton, Mass.)). The various serum albumins are covalently immobilized through free amines onto a carboxymethyl dextran-coated sensor chip CM5 targeting a surface density average of about 77 (58-98) RU. Excess reactive groups on the surfaces (flow cell 1 and 2) are deactivated by injecting 70 μL of 1 M ETA HCl—NaOH pH 8.5 at 10 μL/min.

Examples 23 to 30 are diluted in HBS-EP+ buffer (10 mM HEPES pH 7.6, 150 mM NaCl, 3 mM EDTA, 0.05% Polysorbate 20) at concentrations of 1000, 333.33, 111.11, 37.04, 12.35, 4.12, 1.37, 0.457, 0.152, 0.051 and 0.017 nM. 150 μL of sample is individually injecting sequentially across the immobilized serum albumins surface and then dissociates for 600 sec at 50 μL/min flow rate at 25° C. The surface is regenerated by injecting 10 mM glycine-HCl pH 1.5 (BR-1003-54) at 50 μL/min for 100 sec. The resulting sensorgrams are analyzed using Biacore 8K Insight Evaluation Software (version 2.0.15.12933) 1:1 binding kinetics or steady-state affinity model fitting to calculate the binding kinetic parameter association rate (ka), dissociation rate (kd), and equilibrium dissociation constant (K_(D))

TABLE 1 Binding Kinetics of Example 23 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.2E+05 9.0E−05 7.3E−10 Cyno SA 1.2E+05 8.4E−04 6.8E−09 Mouse SA 1.2E+05 9.3E−03 7.6E−08 Rat SA 1.2E+05 6.5E−03 5.3E−08 Pig SA 9.5E+04 1.2E−02 1.3E−07 Dog SA 1.4E+05 3.3E−03 2.3E−08 Cow SA n/a (steady state) 5.9E−07 Rabbit SA No binding

K_(D) is determined as 0.73, 6.8, 76, 53, 130, 23 and 590 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 23, respectively.

TABLE 2 Binding Kinetics of Example 24 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.4E+05 1.2E−04 9.1E−10 Cyno SA 1.3E+05 7.5E−04 5.5E−09 Mouse SA 1.5E+05 7.3E−03 4.9E−08 Rat SA 1.4E+05 5.7E−03 4.0E−08 Pig SA 1.0E+05 1.1E−02 1.0E−07 Dog SA 1.5E+05 2.4E−03 1.6E−08 Cow SA n/a (steady state) 4.3E−07 Rabbit SA No binding

K_(D) is determined as 0.91, 5.5, 49, 40, 100, 16 and 430 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 24, respectively.

TABLE 3 Binding Kinetics of Example 25 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 2.6E+05 8.4E−05 3.2E−10 Cyno SA 2.3E+05 7.9E−04 3.5E−09 Mouse SA 2.2E+05 9.2E−03 4.2E−08 Rat SA 2.0E+05 6.6E−03 3.4E−08 Pig SA 1.3E+05 1.1E−02 9.0E−08 Dog SA 2.0E+05 3.3E−03 1.6E−08 Cow SA n/a (steady state) 3.9E−07 Rabbit SA No binding

K_(D) is determined as 0.32, 3.5, 42, 34, 90, 16 and 390 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 25, respectively.

TABLE 4 Binding Kinetics of Example 26 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.9E+05 9.4E−05 4.9E−10 Cyno SA 1.8E+05 6.9E−04 3.9E−09 Mouse SA 2.0E+05 6.9E−03 3.5E−08 Rat SA 1.7E+05 5.6E−03 3.2E−08 Pig SA 1.1E+05 9.8E−03 8.7E−08 Dog SA 1.7E+05 2.3E−03 1.3E−08 Bovine SA n/a (steady state) 4.0E−07 Rabbit SA No binding

K_(D) is determined as 0.49, 3.9, 35, 32, 87, 13 and 400 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 26, respectively.

TABLE 5 Binding Kinetics of Example 27 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.7E+05 1.3E−04 7.5E−10 Cyno SA 1.7E+05 7.8E−04 4.7E−09 Mouse SA 1.7E+05 7.9E−03 4.5E−08 Rat SA 1.9E+05 6.1E−03 3.2E−08 Pig SA 1.2E+05 1.0E−02 9.0E−08 Dog SA 1.8E+05 3.0E−03 1.7E−08 Cow SA n/a (steady state) 3.9E−07 Rabbit SA No binding

K_(D) is determined as 0.75, 4.7, 45, 32, 90, 17 and 390 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 27, respectively.

TABLE 6 Binding Kinetics of Example 28 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, Cow and Rabbit Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.6E+05 1.2E−04 7.3E−10 Cyno SA 1.7E+05 6.7E−04 4.1E−09 Mouse SA 1.6E+05 6.0E−03 3.7E−08 Rat SA 1.8E+05 4.8E−03 2.6E−08 Pig SA 1.1E+05 8.4E−03 7.5E−08 Dog SA 1.7E+05 2.1E−03 1.2E−08 Bovine SA n/a (steady state) 4.0E−07 Rabbit SA No binding

K_(D) is determined as 0.73, 4.1, 37, 26, 75, 12 and 400 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 28, respectively.

TABLE 7 Binding Kinetics of Example 29 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, and Cow Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.8E+05 1.3E−04 7.4E−10 Cyno SA 1.8E+05 7.8E−04 4.4E−09 Mouse SA 1.8E+05 8.7E−03 4.8E−08 Rat SA 2.0E+05 6.5E−03 3.2E−08 Pig SA 1.5E+05 1.3E−02 8.6E−08 Dog SA 1.9E+05 3.2E−03 1.6E−08 Bovine SA n/a (steady state) 3.8E−07 Rabbit SA No binding

K_(D) is determined as 0.74, 4.4, 48, 32, 86, 16, 380 nM for human, cynomolgus monkey, mouse, rat, pig, dog, and cow serum albumin binding with Example 29, respectively.

TABLE 8 Binding Kinetics of Example 30 to Human, Cynomolgus Monkey, Mouse, Rat, Pig, Dog, and Cow Serum Albumin at 25° C. Name ka (1/Ms) kd (1/s) K_(D) (M) Human SA 1.6E+05 1.1E−04 7.3E−10 Cyno SA 1.6E+05 6.9E−04 4.3E−09 Mouse SA 1.9E+05 7.1E−03 3.9E−08 Rat SA 1.7E+05 5.1E−03 3.0E−08 Pig SA 1.1E+05 9.2E−03 8.0E−08 Dog SA 1.7E+05 2.2E−03 1.3E−08 Bovine SA n/a (steady state) 3.7E−07 Rabbit SA No binding

K_(D) is determined as 0.73, 4.3, 39, 30, 80, 13 and 370 nM for human, cynomolgus monkey, mouse, rat, pig, dog and cow serum albumin binding with Example 30, respectively.

Example 47: INS Analog In Vitro Potency at IR-A and IR-B

Preparing Membranes: Cellular membranes are prepared from HEK293 cells stably transfected with human IR-A (hIR-A; SEQ ID NO:5) and human IR-B (hIR-B; SEQ ID NO:6) containing a C-terminal C9 tag (TETSQVAPA; SEQ ID NO:83). Typically, cell pellets are from cell passages 6 to 12, depending on the receptor. Frozen cell pellets are thawed in ice-cold homogenization/resuspension buffer (50 mM Tris-HCl, pH 7.5) containing one Complete® protease inhibitor tablet with EDTA (Roche Diagnostics) per 50 mL of buffer. The cells are homogenized with an overhead motor driven Teflon®-glass Potter-Elvehjem homogenizer using 15 to 20 strokes, followed by centrifugation at 1100×g for 10 min at 4° C. The supernatant is saved on ice and the pellets are re-homogenized as before and centrifuged at 1100×g for 10 min at 4° C. All supernatants are combined and subsequently centrifuged at 35,000×g for 60 min at 4° C. The pellet is resuspended in buffer (4 to 5 ml/g of starting cell paste) containing protease inhibitors and quick frozen in liquid nitrogen prior to storage at −80° C. Protein concentration is determined using a BCA kit (ThermoScientific) with bovine serum albumin (BSA) as standard.

Receptor Binding Assay Protocol: Receptor binding affinities (Ki) are determined from a competitive radioligand binding assay with either human recombinant (3-[¹²⁵I]-iodotyrosyl-A14)-insulin (2200 Ci/mmol) or human recombinant [¹²⁵I]-insulin-like growth factor-1 (1680 to 2800 Ci/mmol), both obtained from Perkin Elmer (Waltham, Mass.). The assays are performed with a SPA method using polyvinyltoluene (PVT) wheat germ agglutinin-coupled SPA beads (Perkin Elmer). Assay buffer contains 50 mM Tris-HCl, pH 7.5, 150 mM NaCl and either A) 0.1% w/v fatty-acid free BSA; B) 0.1% w/v fatty-acid free human serum albumin (HSA); C) 0.1% w/v rat serum albumin (RSA); or D) 0.001% Nonidet P-40 Substitute (NP-40, Roche Diagnostics). Ten-point concentration response curves using three-fold serial dilutions of test samples or controls are prepared in Assay Buffer using a Freedom/Evo robot (Tecan). Fifty L of compound dilution is added to 96-well white, clear-bottom microplates (Corning, 3632) with a TeMO robot (Tecan) followed by radioligand (50 μL, about 40 μM final), membranes (50 μL, 0.1 to 0.4 μg/well) and SPA beads (50 μL, 0.1 to 0.15 mg/well), which are added using a Multiflo F/X (Biotek) bulk dispensing instrument. The highest final assay concentrations for test compounds and controls are shown in the table below:

TABLE 9 Receptor Binding Assay Concentrations/Controls. Highest Final Assay Concentration (nM) Compound or Control IR-A/IR-B Binding Compound X 10000-15000 BHI 100 IGF-1 1000 AspB10 INS 40

Following a ten-hour incubation and bead settling at room temperature, radioactivity is determined using a Microbeta™ Trilux scintillation counter (Perkin Elmer) and expressed as counts per minute (CPM).

Samples are tested in three independent assays run on three different days (n=3). For each run, samples are randomized with BHI (SEQ ID NOS:3 and 4), IGF-1 (PeproTech, Inc.; Rocky Hill, N.J.) and AspB10 INS (His10Asp of SEQ ID NO:4) controls included on each plate.

Data Analysis for IR Assays: Each compound is tested with a single replicate concentration response curve per experiment. The maximum binding response (MAX) is determined in an 8 well/plate using assay buffer only, and the minimum binding or nonspecific response (MIN) is determined in each well using 100 nM BHI. All test sample concentration responses are normalized to this control response and calculated as a percent specific inhibition after correcting for nonspecific binding as shown below:

% Specific Inhibition=100−[(CPM−MIN)/(MAX−MIN)×100].

Percent specific inhibition (y-axis) is plotted versus the log concentration of compound (x-axis). Concentrations resulting in 50% inhibition of binding (IC₅₀) are determined from four-parameter logistic non-linear regression analysis (Analyzer, version 15, GeneData Screener). The affinity constant (Ki) is calculated from the IC₅₀ value based upon the equation Ki=IC₅₀/(1+L/Kd), where L equals the concentration of radioligand used in the experiment, and Kd equals the equilibrium binding affinity constant of the radioligand determined from saturation binding analysis. Reported Ki values are shown as the geometric mean with the standard error (Delta Method Standard Error) and the number of independent replicate determinations used to calculate the geometric mean indicated by n.

TABLE 10 In Vitro Potency of Ex.amples 1 to 30 to IR-A hIR-A in hIR=A in hIR-A in 0.001% 0.1% 0.1% NP-40 Ki BSA Ki HSA Ki Name (nM) SEM N (nM) SEM N (nM) SEM N BHI 0.182 0.042 3 0.278 0.032 3 0.298 0.031 3 Ex. 1 19.8 4.6 4 21.3 2.74 7 10.1 1.0 2 Ex. 2 45.1 n/a 1 31.4 7.2 3 31.9 n/a 1 Ex. 3 — — — 45.2 5.3 2 — — — Ex. 4 — — — 591 n/a 1 — — — Ex. 5 — — — 57.0 n/a 1 — — — Ex. 6 — — — 65.5 n/a 1 — — — Ex. 7 14.3 6.0 5 36.1 11.0 5 36.3 n/a 1 Ex. 8 47.3 n/a 1 139 n/a 1 — — — Ex. 9 6.67 n/a 1 11.7 n/a 1 — — — Ex. 10 20.1 n/a 1 146 n/a 1 — — — Ex. 11 20.5 10.7 4 36.0 12.6 4 31.8 n/a 1 Ex. 12 25.0 6.8 5 37.9 15.6 5 42.3 n/a 1 Ex. 13 23.1 11.0 4 60.3 19.6 4 34.6 n/a 1 Ex. 14 163 26 4 282 27 4 124 n/a 1 Ex. 15 13.1 n/a 1 39.2 n/a 1 — — — Ex. 16 43.1 n/a 1 46.0 13.8 3 — — — Ex. 17 31.3 2.8 4 81.8 13.4 4 31.3 n/a 1 Ex. 18 89.5 28.9 4 204 73 4 518 n/a 1 Ex. 19 18.5 n/a 1 41.8 n/a 1 — — — Ex. 20 18.5 n/a 1 51.3 n/a 1 — — — Ex. 21 8.3 n/a 1 28.0 n/a 1 — — — Ex. 22 17.1 n/a 1 59.7 n/a 1 — — — Ex. 23 18.9 n/a 1 55.1 n/a 1 — — — Ex. 24 21.8 n/a 1 56.8 n/a 1 — — — Ex. 25 174 28 3 630 90 3 125 45 3 Ex. 26 105 13 3 389 30 3 40.6 13.8 3 Ex. 27 50.5 n/a 1 103 n/a 1 — — — Ex. 28 32.7 n/a 1 71.0 n/a 1 — — — Ex. 29 34.0 4.3 3 179 8 3 28.2 2.3 3 Ex. 30 49.3 9.9 3 127 23 3 17.2 3.1 3

TABLE 11 In Vitro Potency of Ex.amples 1 to 30 to IR-B hIR-B in hIR−B in hIR-B in 0.001% 0.1% 0.1% NP-40 Ki BSA Ki HSA Ki Name (nM) SEM N (nM) SEM N (nM) SEM N BHI 0.331 0.054 3 0.167 0.028 3 0.165 0.019 3 Ex. 1 52.1 n/a 1 56.6 n/a 1 24.9 n/a 1 Ex. 2 39.2 n/a 1 56.0 n/a 1 29.7 n/a 1 Ex. 3 — — — — — — — — — Ex. 4 — — — — — — — — — Ex. 5 — — — — — — — — — Ex. 6 — — — — — — — — — Ex. 7 45.4 n/a 1 120 n/a 1 47.1 n/a 1 Ex. 8 — — — — — — — — — Ex. 9 — — — — — — — — — Ex. 10 — — — — — — — — — Ex. 11 81.1 n/a 1 164 n/a 1 95.4 n/a 1 Ex. 12 42.8 n/a 1 113 n/a 1 62.1 n/a 1 Ex. 13 39.2 n/a 1 131 n/a 1 89.0 n/a 1 Ex. 14 234 n/a 1 378 n/a 1 447 n/a 1 Ex. 15 — — — — — — — — — Ex. 16 — — — — — — — — — Ex. 17 44.3 n/a 1 110 n/a 1 102 n/a 1 Ex. 18 134 n/a 1 299 n/a 1 239 n/a 1 Ex. 19 — — — — — — — — — Ex. 20 — — — — — — — — — Ex. 21 — — — — — — — — — Ex. 22 — — — — — — — — — Ex. 23 — — — — — — — — — Ex. 24 — — — — — — — — — Ex. 25 641 19 3 790 86 3 279 19 3 Ex. 26 214 49 3 405 66 3 105 15 3 Ex. 27 — — — — — — — — — Ex. 28 — — — — — — — — — Ex. 29 62.5 4.6 3 124 13 3 38.1 3.7 3 Ex. 30 60.0 12.8 3 100 6 3 24.5 5.2 3

In Vivo Function

Example 48: INS Analog Glucose Lowering in Streptozotocin (STZ)-Treated Mice

STZ mice: 11-12 week-old, male, C57B1/6NHsd mice from Envigo RSM Inc. (Indianapolis, Ind.) are allowed to acclimate for a minimum of 3 days. The mice are individually housed in shoebox caging with corn cob bedding and mouse water lixits. Environmental conditions are as follows: photoperiod of 12 hours light and 12 hours dark (may be interrupted for study-related activities), temperature of 20° C. to 26° C., and relative humidity of 30% to 70%.

STZ is prepared as follows: add vehicle to pre-weighed STZ to achieve a dosing concentration of 16.67 mg/mL. Gently swirl to mix until powder is dissolved. Solution is kept on wet ice, protected from light and is used within 3 hr of preparation. On days 5 and 9 of pre-dose phase, prior to each STZ administration, following an overnight fast (not to exceed 16 hr), animals are dosed i.p. at a dose volume 6 mL/kg (100 mg/kg), based on most recent body weight. Any animal with a body weight below 19 g is not administered STZ.

Ten days after a second STZ treatment, animals are assigned to the study using a block randomization allocation tool (BRAT) designed to achieve glucometer value (250 mg/dL to 500 mg/dL inclusion criteria) and body weight balance. A single dose of pre-formulated test article is administered into the subcutaneous space between the shoulder blades (interscapular) at a dose volume of 10 mL/kg. Any possible dosing errors are noted.

Following test article treatment, body weight is monitored each morning. Food intake is monitored on days 1 (thrice: 0 to 4 hr, 4 to 12 hr and 12 to 24 hr), 2, 3, 4, 5, 6, 7 and 8. Glucose measurements are taken via tail clip using glucometers (in duplicate) 0, 4, 12, 24, 36, 48, 72, 96, 120, 144 and 168 hr post dose. At 4, 12, 24, 36, 48 and 72 hr post dose, an additional 40 μL of whole blood is collected for determining compound concentration.

All data is presented as mean±SEM of 5 animals per group. Percent change in glucose is calculated for each time point as follows: percent change at X hours post dose=((X time point glucose−animal's time 0 post dose glucose)×100)−100.

As shown below in Table 12, the INS analogs of Examples 1 to 6 demonstrate a sustained reduction in whole blood glucose levels after a single, 300 nmol/kg injection. Likewise, and as shown below in Tables 13 and 14, the INS analogs of Examples 7 to 18 demonstrate sustained reduction in whole blood glucose levels after a single, 200 nmol/kg injection.

TABLE 12 Glucose-Lowering Effect of 300 nmol/kg Dose of Examples 1 to 6 in STZ-Treated Mice Dose % Change in Glucose Name (nmol/kg) N 4 hr 12 hr 24 hr 36 hr 48 hr 72 hr 96 hr 120 hr 144 hr 168 hr Vehicle n/a 5 1.5 −9.9 1.8 −5.9 −0.1 4.2 −11.7 2.1 −15.2 −12.4 Ex. 1 300 5 −54.6 −26.2 −71.5 −75.8 −78.0 −77.0 −52.9 −33.9 −20.7 −19.1 Ex. 2 300 5 −66.6 −75.9 −80.0 −82.3 −82.6 −85.5 −52.7 −35.3 −24.0 −23.7 Ex. 3 300 5 −56.6 −61.7 −70.8 −82.9 −80.7 −80.1 −66.8 −45.9 −29.6 −25.0 Ex. 4 300 5 −33.5 −46.2 −63.6 −64.3 −73.3 −73.2 −63.6 −62.2 −50.4 −42.0 Ex. 5 300 5 −61.2 −71.7 −75.4 −81.8 −79.9 −84.8 −81.9 −75.4 −66.6 −52.5 Ex. 6 300 5 −64.5 −58.3 −74.9 −84.5 −79.4 −81.5 −62.2 −54.8 −41.8 −26.9 Vehicle n/a 5 5.8 18.9 4.9 6.2 2.0 3.0 4.2 3.0 4.2 8.0 Ex. 1 300 5 11.3 27.0 3.7 2.5 2.9 2.3 2.8 3.6 3.9 6.9 Ex. 2 300 5 1.7 1.8 1.4 0.6 2.0 1.5 6.4 4.4 4.9 7.2 Ex. 3 300 5 5.2 11.1 5.1 1.8 3.7 2.9 3.8 3.9 4.6 3.4 Ex. 4 300 5 7.3 6.8 6.7 8.8 3.4 4.5 3.9 2.2 2.2 2.9 Ex. 5 300 5 7.1 5.2 2.8 1.9 2.0 1.7 1.9 2.8 2.2 3.7 Ex. 6 300 5 6.7 8.9 4.9 0.8 2.9 4.3 4.7 6.8 4.9 3.6

TABLE 13 Glucose-Lowering Effect of 200 nmol/kg Dose of Ex.amples 9 and 11 to 16 in STZ-Treated Mice Dose % Change in Glucose Name (nmol/kg) N 4 hr 12 hr 24 hr 36 hr 48 hr 72 hr 96 hr 120 hr 144 hr 168 hr Vehicle n/a 5 24.4 18.2 19.2 27.0 20.9 24.2 13.1 17.0 16.4 19.0 Ex. 9 200 5 −70.9 −42.0 −73.0 −75.0 −84.0 −83.1 −54.6 −33.2 −11.7 −14.7 Ex. 11 200 5 −58.3 −42.4 −50.6 −46.9 −67.7 −73.2 −74.7 −69.3 −61.8 −49.5 Ex. 12 200 5 −57.9 −58.9 −75.2 −71.4 −81.5 −85.1 −84.4 −73.5 −54.2 −47.7 Ex. 13 200 5 −45.3 −44.7 −62.6 −69.0 −79.2 −79.8 −73.6 −66.4 −62.9 −54.9 Ex. 14 200 5 −35.9 −30.9 −66.1 −58.4 −79.9 −78.5 −77.7 −68.1 −60.3 −55.5 Ex. 15 200 5 −68.0 −71.3 −75.4 −80.1 −79.2 −76.4 −52.2 −23.9 −17.8 −16.3 Ex. 16 200 5 −59.5 −53.6 −64.7 −75.8 −75.4 −74.2 −43.2 −29.9 −21.5 −25.4 Vehicle n/a 5 7.8 4.7 5.9 6.1 4.7 7.5 7.1 8.2 8.1 8.3 Ex. 9 200 5 2.7 6.3 4.6 3.9 0.3 0.5 1.6 3.7 2.0 2.6 Ex. 11 200 5 3.9 9.2 9.9 11.1 6.4 3.0 1.3 2.8 2.0 6.7 Ex. 12 200 5 9.9 10.1 2.1 4.2 1.3 0.7 2.0 3.6 9.2 7.0 Ex. 13 200 5 9.0 12.0 7.1 9.4 2.6 1.3 2.8 4.3 3.7 7.2 Ex. 14 200 5 11.0 9.1 8.0 10.0 1.5 3.1 2.4 1.7 4.3 2.9 Ex. 15 200 5 5.3 2.9 4.0 1.4 3.6 4.6 4.7 6.3 5.5 4.2 Ex. 16 200 5 5.3 9.6 6.8 3.7 4.9 4.1 8.1 5.4 4.0 2.8

TABLE 14 Glucose Lowering Effect of 200 nmol/kg Dose of Ex.amples 7, 8, 10, 14, 17 and 18 in STZ-Treated Mice Dose % Change in Glucose Name (nmol/kg) N 4 hr 12 hr 24 hr 36 hr 48 hr 72 hr 96 hr 120 hr 144 hr 168 hr Vehicle n/a 5 3.85 7.49 2.56 18.83 10.33 3.84 0.08 1.81 1.08 −6.92 Ex. 7 200 5 −63.1 −41.3 −71.1 −67.2 −80.0 −80.2 −59.6 −37.8 −15.8 −17.1 Ex. 8 200 5 −46.1 −50.8 −71.5 −73.8 −78.0 −81.8 −65.7 −52.5 −43.1 −17.4 Ex. 10 200 5 −55.6 −56.1 −71.6 −58.8 −73.2 −79.6 −73.6 −66.7 −58.7 −47.3 Ex. 14 200 5 −30.2 −26.7 −66.7 −59.1 −71.3 −77.5 −74.6 −53.2 −55.6 −49.4 Ex. 17 200 5 −45.8 −22.3 −62.8 −49.6 −78.2 −78.4 −84.6 −70.5 −73.8 −63.7 Ex. 18 200 5 −50.1 −30.7 −67.0 −69.2 −81.0 −83.4 −81.4 −72.4 −62.0 −52.2 Vehicle n/a 5 2.3 4.6 5.0 4.3 7.2 5.3 4.1 3.8 6.5 7.2 Ex. 7 200 5 4.9 10.0 2.8 8.1 2.7 3.8 5.6 8.8 13.5 7.9 Ex. 8 200 5 9.8 7.0 2.0 2.6 1.1 1.1 5.2 7.1 6.4 6.6 Ex. 10 200 5 3.4 7.5 1.4 3.9 2.7 1.1 3.0 4.8 1.1 1.5 Ex. 14 200 5 6.2 8.8 3.1 9.2 2.8 2.1 1.3 3.0 5.4 5.7 Ex. 17 200 5 7.1 3.5 4.7 11.4 2.7 6.1 1.7 4.7 1.4 1.6 Ex. 18 200 5 4.6 3.5 3.6 6.5 1.9 0.5 2.2 2.9 3.8 7.2

Example 49: INS Analog Glucose Lowering in STZ-Treated Rats

390-425 g, male Sprague Dawley rats from Envigo RMS Inc. (Indianapolis, Ind.) are allowed to acclimate for a minimum of 3 days. The rats are individually housed in shoebox caging with corn cob bedding and water lixits providing water ad libitum. Rats are fed Teklad Global Diets' Rodent 2014 feed. Environmental conditions as follows: photoperiod of 12 hr light and 12 hr dark (may be interrupted for study-related activities), temperature of 20° C. to 26° C., and relative humidity of 30% to 70%.

STZ is prepared as follows: 19 mL of cold sterile saline is added to a STZ vial (Zanosar®, Teva Parenteral Medicines, Inc., Irvine, Calif.) and is gently mixed until powder is dissolved. Repeat with a second vial of STZ, keep both on wet ice, and shield from light. These solutions are good for 3 hr under stated conditions. On day 8 of pre-dose phase, following a 6-hr fast, animals are dosed i.v. at a dose volume 0.8 mL/kg (40 mg/kg), based on most recent body weight. STZ dosing is done under anesthesia with Isoflurane. Rats are observed until fully awake.

Three days after STZ treatment, animals are assigned to the study using a BRAT designed to achieve glucometer value (450 mg/dL to 550 mg/dL inclusion criteria) and body weight balance. 50 out of the 60 rats are put on study. A single dose of pre-formulated test article (INS analogs at 50, 100, 200 and 400 nmol/kg in 20 mM histidine, 50 mM NaCl, pH 6.0) is administered into the subcutaneous space at a dose volume of 5 mL/kg.

Following test article treatment, body weight and food intake is monitored each morning (days 1-11 of dosing phase). Glucose measurements are taken via tail clip using glucometers (AccuChek® Aviva®, Roche, Indianapolis, Ind.) (in duplicate) at 0, 2, 4, 6, 8, 10, 12, 18, 24, 36, 48, 72, 96, 120, 144, 168, 192, 216 and 240 hr post dose.

All data is presented as mean±SEM of 4-5 animals per group. Percent change in glucose is calculated for each time point as follows: percent change at X hours post dose=((X time point glucose−animal's time 0 post dose glucose)×100)−100.

As shown below in Table 15, all four INS analogs demonstrate a dose-dependent (50, 100, 200 and 400 nmol/kg) reduction in whole blood glucose levels after a single injection.

TABLE 15 Glucose-Lowering Effect of Varied Doses of Ex.amples 25 and 26 in STZ-Treated Rats Dose % Change in Glucose (nmol/ 2 4 6 8 10 12 18 24 36 48 72 96 120 144 Name kg) N hr hr hr hr hr hr hr hr hr hr hr hr hr hr Vehicle n/a 5 −3.2 12.2 −8.6 −2.4 5.6 13.0 3.7 14.4 16.3 −1.1 1.7 0.9 −0.6 6.4 Ex. 25  50 5 −1.7 −4.5 12.5 −4.8 −8.3 12.1 5.7 −2.8 12.1 10.6 −6.6 11.1 −9.3 −2.5 Ex. 25 100 5 −2.6 −9.8 13.8 13.4 −7.3 20.5 11.0 −7.7 16.4 1.4 11.0 −6.1 −8.1 0.5 Ex. 25 200 5 13.7 26.5 29.9 31.0 14.9 16.3 2.9 38.0 10.0 26.2 41.1 45.1 23.3 11.5 Ex. 25 400 5 −6.3 24.1 40.4 54.1 43.3 −8.1 26.9 62.7 14.8 65.1 75.6 73.9 68.6 54.7 Ex. 26  50 5 6.6 −7.0 −3.5 −7.6 13.5 23.1 16.9 −6.9 17.3 1.5 11.5 19.6 19.0 −7.6 Ex. 26 100 5 1.1 −9.8 15.3 19.2 14.8 10.7 17.4 40.4 10.8 31.9 13.5 14.9 −9.7 1.9 Ex. 26 200 5 7.1 10.7 19.3 22.2 −5.0 9.5 −8.8 50.7 −8.2 43.9 53.8 55.7 51.4 28.2 Ex. 26 400 5 −4.0 18.4 44.0 48.7 46.3 27.2 22.5 72.9 37.8 81.8 85.8 82.6 73.9 61.8 Vehicle n/a 5 6.1 2.7 7.2 8.7 9.2 2.8 7.3 13.0 2.2 5.0 3.1 2.4 5.8 6.2 Ex. 25  50 5 3.4 5.2 5.7 9.8 8.9 4.2 2.4 7.7 4.3 7.3 3.4 3.9 4.3 4.8 Ex. 25 100 5 8.8 6.8 5.3 9.0 13.5 5.7 3.8 6.9 7.6 4.7 5.3 5.4 5.0 5.7 Ex. 25 200 5 8.5 3.8 9.4 12.5 16.5 2.3 6.1 12.6 4.9 4.0 6.0 12.0 4.9 6.2 Ex. 25 400 5 10.6 7.4 8.4 10.6 6.2 10.6 9.0 19.0 6.7 12.0 6.4 8.8 9.7 10.2 Ex. 26  50 5 9.3 7.2 7.7 8.2 13.2 8.6 8.5 7.3 8.9 6.3 23.1 21.5 21.0 23.7 Ex. 26 100 5 5.9 7.4 9.1 11.6 12.1 6.9 14.4 11.4 20.4 16.5 6.6 6.0 5.1 5.1 Ex. 26 200 5 1.7 6.1 2.8 5.6 6.2 1.7 4.3 9.4 2.2 6.0 4.5 10.4 8.8 7.6 Ex. 26 400 5 5.4 14.9 12.8 10.4 16.5 11.9 9.5 6.8 10.9 2.3 1.2 2.0 4.8 5.6 Glucose-Lowering Effect of Varied Doses of Ex.amples 25 and 26 in STZ-Treated Rats Dose % Change in Glucose (nmol/ 168 192 216 240 Name kg) hr hr hr hr Vehicle n/a 3.7 4.3 4.7 14.5 Ex. 25  50 3.8 2.6 0.0 6.4 Ex. 25 100 −1.8 1.9 7.1 13.9 Ex. 25 200 17.4 −2.5 6.3 18.1 Ex. 25 400 32.8 17.9 15.2 3.6 Ex. 26  50 13.5 15.0 10.1 −5.9 Ex. 26 100 7.1 7.0 15.3 16.7 Ex. 26 200 24.4 18.7 −9.0 10.0 Ex. 26 400 44.1 54.5 23.8 −5.5 Vehicle n/a 3.8 5.3 6.8 5.4 Ex. 25  50 7.3 4.7 6.4 6.5 Ex. 25 100 4.7 6.0 4.6 6.3 Ex. 25 200 7.4 7.9 4.0 3.7 Ex. 25 400 7.8 11.7 10.2 9.1 Ex. 26  50 22.2 22.9 23.7 25.2 Ex. 26 100 5.4 2.6 4.4 4.5 Ex. 26 200 2.9 1.0 3.1 2.2 Ex. 26 400 8.1 6.8 9.5 9.5

TABLE 16 Glucose Lowering Effect of Varied Doses of Examples 29 and 30 in STZ-Treated Rats % change in Glucose Dose 2 4 6 8 10 12 18 24 36 48 72 96 120 Name (nmol/kg) N hr hr hr hr hr hr hr hr hr hr hr hr hr Vehicle n/a 5 3.0 3.9 −9.7 −4.9 11.3 16.8 12.8 −3.0 18.6 6.9 7.0 11.7 7.0 Ex. 29 50 5 1.5 0.9 −3.9 11.5 2.7 15.4 5.0 15.8 12.6 10.3 10.1 10.0 −3.9 Ex. 29 100 5 6.1 2.1 14.1 19.4 −0.9 7.2 −5.4 32.8 3.2 26.8 40.2 27.5 21.8 Ex. 29 200 5 −1.1 −3.4 −8.1 21.7 13.0 5.7 −5.6 38.1 6.2 35.1 71.1 75.5 64.6 Ex. 29 400 5 11.8 36.0 63.8 74.6 67.7 41.3 35.2 70.3 38.8 83.8 84.7 84.7 86.8 Ex. 30 50 5 0.7 −0.4 11.4 −8.9 2.9 12.0 0.1 −5.2 11.4 16.6 15.0 19.0 15.8 Ex. 30 100 5 −4.3 −5.1 16.6 16.6 11.1 3.8 0.3 16.6 1.3 28.6 35.5 25.3 29.3 Ex. 30 200 5 7.3 −0.9 19.5 19.9 34.5 0.8 −8.3 49.7 1.2 45.6 67.2 72.2 66.7 Ex. 30 400 5 −1.8 18.0 38.5 66.9 42.0 11.8 26.1 62.7 38.0 74.8 83.9 85.1 84.2 Vehicle n/a 5 3.9 8.6 5.7 7.3 4.4 4.3 4.2 3.3 4.6 4.7 4.9 5.0 5.8 Ex. 29 50 5 2.2 3.4 3.3 3.2 8.4 4.8 2.2 13.1 3.1 4.4 2.9 3.0 4.3 Ex. 29 100 5 3.5 4.0 2.3 4.6 5.6 3.1 5.7 8.8 3.5 2.8 6.1 5.0 3.4 Ex. 29 200 5 4.8 4.1 7.7 7.8 13.8 6.4 4.7 11.4 2.9 6.4 3.6 6.4 6.0 Ex. 29 400 5 3.3 5.9 11.8 6.3 5.6 8.4 7.2 6.5 7.9 0.2 1.4 1.7 1.2 Ex. 30 50 5 4.0 5.9 6.0 6.8 7.3 4.1 3.2 5.5 4.2 7.1 8.2 5.6 4.3 Ex. 30 100 5 4.9 1.7 3.7 7.6 10.1 6.2 4.3 4.1 2.6 8.7 6.0 10.4 9.6 Ex. 30 200 5 4.6 6.6 3.4 14.1 16.4 5.8 2.3 11.6 1.8 9.1 5.5 3.1 2.5 Ex. 30 400 5 6.3 8.1 11.4 5.8 7.9 4.0 8.8 13.9 10.4 9.4 2.5 1.6 2.2 Glucose Lowering Effect of Varied Doses of Examples 29 and 30 in STZ-Treated Rats % change in Glucose Dose 144 168 192 216 240 Name (nmol/kg) hr hr hr hr hr Vehicle n/a 3.4 4.5 12.1 8.7 11.0 Ex. 29 50 −8.5 0.7 6.5 3.3 4.8 Ex. 29 100 18.8 17.6 −6.0 −8.7 −2.2 Ex. 29 200 53.0 41.1 23.7 14.6 −3.6 Ex. 29 400 85.5 84.0 70.8 64.5 44.9 Ex. 30 50 12.7 −4.1 2.7 4.0 0.2 Ex. 30 100 15.2 −9.4 −6.8 −4.2 −0.2 Ex. 30 200 65.6 39.7 25.0 21.7 16.0 Ex. 30 400 82.0 72.1 61.8 57.0 43.4 Vehicle n/a 5.6 4.3 6.3 5.4 3.6 Ex. 29 50 3.8 2.5 1.3 3.9 3.3 Ex. 29 100 4.0 3.5 4.6 5.2 3.4 Ex. 29 200 8.4 10.2 5.1 4.7 5.7 Ex. 29 400 1.1 1.8 3.4 8.7 7.6 Ex. 30 50 3.5 5.2 6.7 5.3 6.8 Ex. 30 100 3.8 6.9 5.1 4.0 1.8 Ex. 30 200 7.4 8.2 8.9 6.2 3.7 Ex. 30 400 3.8 8.0 6.8 6.9 8.0

Example 50: INS Analog Pharmacokinetics in STZ-Treated Rats

The pharmacokinetics of the INS analogs herein are tested in an STZ-induced diabetic rat model. Male STZ-treated rats are administered single, subcutaneous doses of various INS analogs at 50, 100, 200 or 400 nmol/kg (5 mL/kg dose in 20 mM histidine, 50 mM NaCl, pH 6.0). Blood is collected from each animal pre-dose and at 2, 4, 6, 8, 10, 12, 18, 24, 36, 48, 72, 96, 120, 144, 168, 192, 216 and 240 hr post-dose. The blood samples are processed to K3EDTA plasma and are stored frozen at about −70° C. The INS analog concentrations in plasma are measured at Eli Lilly and Company (Indianapolis, Ind.), and the concentration-time data are used to calculate pharmacokinetic parameters (see, Table 12).

Plasma analog concentrations are measured from the animals by immunoaffinity-LC/MS using a Thermo orbitrap mass spectrometer (Q/Exactive or Fusion Lumos) coupled to a Dionex Ultimate 3000 UPLC system. The analogs are immunoprecipitated from K₃EDTA rat plasma using an anti-camelid-VHH-biotin monoclonal antibody (Eli Lilly and Company, clone 96A3F5) immobilized to streptavidin-coated magnetic beads (Dynal M-280, Thermo E2017-02). Following wash steps to remove non-specifically bound proteins, the variants are reduced (triethylphosphine, Aldrich 245275-5G), alkylated (2-iodoethanol, Aldrich 176850-25G) and are digested (Trypsin Gold, Promega E2019-12). The subsequent tryptic peptides from various regions of the variants are measured by LC/MS over the range of 0.293 nM to 150 nM as a surrogate measure of intact analog.

The pharmacokinetics of Examples 29 and 30 are about linear over the range of doses tested (50 to 400 nmol/kg SC). Apparent clearance for the two analogs ranges from 2.9 mL/hr/kg to 4.7 mL/hr/kg, and their elimination half-lives ranges from 25 hr to 42 hr (see, Table 17).

TABLE 17 Mean Pharmacokinetic Parameters of INS Analogs of Examples 29 and 30 Following Single 50, 100, 200 or 400 nmol/kg Subcutaneous Doses to Male STZ-Cmax/DoseTreated Rats. Dose (nmol/ AUC_(0-∞) (kg * nmol/ Tmax CL/F t½ Name kg) (hr * uM) L/nmol) (hr) (mL/hr/kg) (hr) Ex. 29 50 16.3 2.92 43 3.14 33.5 (2.7) (0.6) (H) (0.6) (3.8) 100 31.1 3.11 34 3.25 42.1 (3.2) (0.8) (13) (0.4) (5.6) 200 69.8 3.80 34 2.99 41.7 (16) (0.8) (10) (0.7) (3.0) 400 150 3.56 22 2.77 25.1 (30) (0.5) (15) (0.7) (2.9) Ex. 30 50 24.8 4.71 36 2.09 34.5 (5.5) (1.8) (8) (0.4) (5.2) 100 39.2 3.90 53 2.59 27.7 (5.1) (0.8) (25) (0.3) (3.3) 200 69.3 3.68 31 2.94 32.1 (10) (1.2) (H) (0.5) (3.3) 400 180 3.87 96 2.26 33.3 (24) (0.6) (0) (0.3) (1.5) Mean +/− (SD), N = 5 Abbreviations: AUC_(0-∞) = area under the curve from time 0 hours to infinity, CL/F = clearance/bioavailability, T_(max) = time to maximal concentration, C_(max)/Dose = maximum observed plasma concentration divided by the dose, t_(1/2) = half−life.

SEQUENCES

The following nucleic and/or amino acid sequences are referred to in the disclosure and are provided below for reference.

SEQ ID NO: 1-human preproinsulin (110 amino acids; NCBI Ref. No. NP_001278826.1) MALWMRLLPLLALLALWGPDPAAAFVNQHLCGSHLVEALYLVCGERGFFYTPK TRREAEDLQVGQVELGGGPGAGSLQPLALEGSLQKRGIVEQCCTSICSLYQLENY CN SEQ ID NO: 2-human proinsulin (86 amino acids; 25-110 of NCBI Ref. No. NP_001278826.1) FVNQHLCGSHLVEALYLVCGERGFFYTPKTRREAEDLQVGQVELGGGPGAGSLQ PLALEGSLQKRGIVEQCCTSICSLYQLENYCN SEQ ID NO: 3-human INS A chain (21 amino acids; 90-110 of NCBI Ref. No. NP_001278826.1) GIVEQCCTSICSLYQLENYCN SEQ ID NO: 4-human INS B chain (30 amino acids; 25-54 of NCBI Ref. No. NP_001278826.1) FVNQHLCGSHLVEALYLVCGERGFFYTPKT SEQ ID NO: 5-human INS receptor-A (1370 amino acids; NCBI Ref. No. NP_001073285.1) with C-terminal C9 tag MATGGRRGAAAAPLLVAVAALLLGAAGHLYPGEVCPGMDIRNNLTRLHELENC SVIEGHLQILLMFKTRPEDFRDLSFPKLIMITDYLLLFRVYGLESLKDLFPNLTVIR GSRLFFNYALVIFEMVHLKELGLYNLMNITRGSVRIEKNNELCYLATIDWSRILDS VEDNYIVLNKDDNEECGDICPGTAKGKTNCPATVINGQFVERCWTHSHCQKVCP TICKSHGCTAEGLCCHSECLGNCSQPDDPTKCVACRNFYLDGRCVETCPPPYYHF QDWRCVNFSFCQDLHHKCKNSRRQGCHQYVIHNNKCIPECPSGYTMNSSNLLCT PCLGPCPKVCHLLEGEKTIDSVTSAQELRGCTVINGSLIINIRGGNNLAAELEANLG LIEEISGYLKIRRSYALVSLSFFRKLRLIRGETLEIGNYSFYALDNQNLRQLWDWS KHNLTITQGKLFFHYNPKLCLSEIHKMEEVSGTKGRQERNDIALKTNGDQASCEN ELLKFSYIRTSFDKILLRWEPYWPPDFRDLLGFMLFYKEAPYQNVTEFDGQDACG SNSWTVVDIDPPLRSNDPKSQNHPGWLMRGLKPWTQYAIFVKTLVTFSDERRTY GAKSDIIYVQTDATNPSVPLDPISVSNSSSQIILKWKPPSDPNGNITHYLVFWERQA EDSELFELDYCLKGLKLPSRTWSPPFESEDSQKHNQSEYEDSAGECCSCPKTDSQI LKELEESSFRKTFEDYLHNVVFVPRPSRKRRSLGDVGNVTVAVPTVAAFPNTSST SVPTSPEEHRPFEKVVNKESLVISGLRHFTGYRIELQACNQDTPEERCSVAAYVSA RTMPEAKADDIVGPVTHEIFENNVVHLMWQEPKEPNGLIVLYEVSYRRYGDEEL HLCVSRKHFALERGCRLRGLSPGNYSVRIRATSLAGNGSWTEPTYFYVTDYLDVP SNIAKIIIGPLIFVFLFSVVIGSIYLFLRKRQPDGPLGPLYASSNPEYLSASDVFPCSV YVPDEWEVSREKITLLRELGQGSFGMVYEGNARDIIKGEAETRVAVKTVNESASL RERIEFLNEASVMKGFTCHHVVRLLGVVSKGQPTLVVMELMAHGDLKSYLRSLR PEAENNPGRPPPTLQEMIQMAAEIADGMAYLNAKKFVHRDLAARNCMVAHDFT VKIGDFGMTRDIYETDYYRKGGKGLLPVRWMAPESLKDGVFTTSSDMWSFGVV LWEITSLAEQPYQGLSNEQVLKFVMDGGYLDQPDNCPERVTDLMRMCWQFNPK MRPTFLEIVNLLKDDLHPSFPEVSFFHSEENKAPESEELEMEFEDMENVPLDRSSH CQREEAGGRDGGSSLGFKRSYEEHIPYTHMNGGKKNGRILTLPRSNPSAAAGTET SQVAPA SEQ ID NO: 6-human INS receptor-B (1382 amino acids; NCBI Ref. No. NP_000199.2) with C-terminal C9 tag MATGGRRGAAAAPLLVAVAALLLGAAGHLYPGEVCPGMDIRNNLTRLHELENC SVIEGHLQILLMFKTRPEDFRDLSFPKLIMITDYLLLFRVYGLESLKDLFPNLTVIR GSRLFFNYALVIFEMVHLKELGLYNLMNITRGSVRIEKNNELCYLATIDWSRILDS VEDNYIVLNKDDNEECGDICPGTAKGKTNCPATVINGQFVERCWTHSHCQKVCP TICKSHGCTAEGLCCHSECLGNCSQPDDPTKCVACRNFYLDGRCVETCPPPYYHF QDWRCVNFSFCQDLHHKCKNSRRQGCHQYVIHNNKCIPECPSGYTMNSSNLLCT PCLGPCPKVCHLLEGEKTIDSVTSAQELRGCTVINGSLIINIRGGNNLAAELEANLG LIEEISGYLKIRRSYALVSLSFFRKLRLIRGETLEIGNYSFYALDNQNLRQLWDWS KHNLTITQGKLFFHYNPKLCLSEIHKMEEVSGTKGRQERNDIALKTNGDQASCEN ELLKFSYIRTSFDKILLRWEPYWPPDFRDLLGFMLFYKEAPYQNVTEFDGQDACG SNSWTVVDIDPPLRSNDPKSQNHPGWLMRGLKPWTQYAIFVKTLVTFSDERRTY GAKSDIIYVQTDATNPSVPLDPISVSNSSSQIILKWKPPSDPNGNITHYLVFWERQA EDSELFELDYCLKGLKLPSRTWSPPFESEDSQKHNQSEYEDSAGECCSCPKTDSQI LKELEESSFRKTFEDYLHNVVFVPRKTSSGTGAEDPRPSRKRRSLGDVGNVTVAV PTVAAFPNTSSTSVPTSPEEHRPFEKVVNKESLVISGLRHFTGYRIELQACNQDTPE ERCSVAAYVSARTMPEAKADDIVGPVTHEIFENNVVHLMWQEPKEPNGLIVLYE VSYRRYGDEELHLCVSRKHFALERGCRLRGLSPGNYSVRIRATSLAGNGSWTEPT YFYVTDYLDVPSNIAKIIIGPLIFVFLFSVVIGSIYLFLRKRQPDGPLGPLYASSNPEY LSASDVFPCSVYVPDEWEVSREKITLLRELGQGSFGMVYEGNARDIIKGEAETRV AVKTVNESASLRERIEFLNEASVMKGFTCHHVVRLLGVVSKGQPTLVVMELMA HGDLKSYLRSLRPEAENNPGRPPPTLQEMIQMAAEIADGMAYLNAKKFVHRDLA ARNCMVAHDFTVKIGDFGMTRDIYETDYYRKGGKGLLPVRWMAPESLKDGVFT TSSDMWSFGVVLWEITSLAEQPYQGLSNEQVLKFVMDGGYLDQPDNCPERVTD LMRMCWQFNPKMRPTFLEIVNLLKDDLHPSFPEVSFFHSEENKAPESEELEMEFE DMENVPLDRS SHCQREEAGGRDGGS SLGFKRSYEEHIPYTHMNGGKKNGRILTL PRSNPSAAAGTETSQVAPA SEQ ID NO: 7-VHH moiety #1 (MC6.1C22.43) EVQLLESGGGLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKEREFVAGIGGG VDITYYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKV ADLYPYWGQGTLVTVSSPP SEQ ID NO: 8-VHH moiety #2 (MC6.1) EVQLLESGGGLVQPGGSLRLSCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGS VDITYYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRD ANLYDYWGQGTLVTVSS SEQ ID NO: 9-VHH moiety #3 (MC6.1C80.43) EVQLLESGGGLVQPGGSLRLSCAASGRYIDETAVAWFRQAPGKGREFVAGIGGG VDITYYADSVKGRFTISRDNSKNTLYLQMNSLRPEDTAVYYCAARPGRPLITSKV ADLYPYWGQGTLVTVSSPP SEQ ID NO: 10-L₁ (basic sequence of (GGGGQ)_(n)) (GGGGQ)_(n) SEQ ID NO: 11-L₁ (basic sequence of (GGGQ)_(n)) (GGGQ)_(n) SEQ ID NO: 12-L₁ (basic sequence of (GGGGS)_(n)) (GGGGS)_(n) SEQ ID NO: 13-L₁ (basic sequence of (PGPQ)_(n)) (PGPQ)_(n) SEQ ID NO: 14-L₁ (basic sequence of (PGPA)_(n)) (PGPA)_(n) SEQ ID NO: 15-L₁ (basic sequence of (GGE)_(n)GG) (GGE)_(n)GG SEQ ID NO: 16-L₁ (basic sequence of (GGGGE)_(n)GGGG) (GGGGE)_(n)GGGG SEQ ID NO: 17-L₁ (basic sequence of (GGGGK)_(n)GGGG) (GGGGK)_(n)GGGG SEQ ID NO: 18-L₁ (basic sequence of (GGGG(AP)_(n)GGGG) GGGG(AP)GGGG SEQ ID NO: 19-L₁ (basic sequence of GGGG(EP)_(n)) GGGG(EP)_(n)GGGG SEQ ID NO: 20-L₁ (basic sequence of GGGG(KP)_(n)GGGG) GGGG(KP)GGGG SEQ ID NO: 21-L₁ (basic sequence of (PGPE)_(n)PGPQ) (PGPE)_(n)PGPQ SEQ ID NO: 22-L₁ (basic sequence of (PGPK)_(n)PGPQ) (PGPK)_(n)PGPQ SEQ ID NO: 23-L₁ #1 ((GGGGQ)₅) GGGGQGGGGQGGGGQGGGGQGGGGQ SEQ ID NO: 24-L₁ #2 ((PGPQ)) PGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQ SEQ ID NO: 25-L₁ #3 ((PGPA)₈) PGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPA SEQ ID NO: 26-L₁ #4 (G₂E)₇G₂ GGEGGEGGEGGEGGEGGEGGEGG SEQ ID NO: 27-L₁ #5 (G₄E)₄G₄ GGGGEGGGGEGGGGEGGGGEGGGG SEQ ID NO: 28-L₁ #6 (G₄K)₄G₄ GGGGKGGGGKGGGGKGGGGKGGGG SEQ ID NO: 29-L₁ #7 (G₄(AP)₁₀G₄) GGGGAPAPAPAPAPAPAPAPAPAPGGGG SEQ ID NO: 30-L₁ #7 (G₄(EP)₁₀G₄) GGGGEPEPEPEPEPEPEPEPEPEPGGGG SEQ ID NO: 31-L₁ #8 (G₄(KP)₁₀G₄) GGGGKPKPKPKPKPKPKPKPKPKPGGGG SEQ ID NO: 32-L₁ #9 ((PGPE)₇PGPQ) PGPEPGPEPGPEPGPEPGPEPGPEPGPEPGPQ SEQ ID NO: 33-L₁ #10 ((PGPK)₇PGPQ) PGPKPGPKPGPKPGPKPGPKPGPKPGPKPGPQ SEQ ID NO: 34-L₂ #1 GGGGGG SEQ ID NO: 35-L₂ #2 GGGSGGSGGG SEQ ID NO: 36-L₂ #3 GGGSGGSGGSGGG SEQ ID NO: 37-INS Analog #1 (SCI(A21G)-(PGPA)₈-MC6.1) FVNQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 38-INS Analog #2 (SCI(B3D, A21G)-(PGPA)₈-MC6.1) FVDQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 39-INS Analog #3 (SCI(B9A, A21G)-(PGPA)₈-MC6.1) FVNQHLCGAHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLEN YCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRL SCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNS KNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 40-INS Analog #4 (SCI(B16E, A21G)-(PGPA)₈-MC6.1) FVNQHLCGSHLVEALELVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 41-INS Analog #5 (SCI(B16H, A21G)-(PGPA)₈-MC6.1) FVNQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 42-INS Analog #6 (SCI(B25H, A21G)-(PGPA)₈-MC6.1) FVNQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLYQLEN YCGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRL SCAASGRTVSSTAVAWFRQAPGKEREFVAGIGGSVDITYYADSVKGRFTISRDNS KNTLYLQMNSLRPEDTAVYYCAVRPGRPLITSRDANLYDYWGQGTLVTVSS SEQ ID NO: 43-INS Analog #7 (SCI(B3S, A21G)-(PGPA)₈-MC6.1C22.43) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 44-INS Analog #8 (SCI(B3S, B25H, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 45-INS Analog #9 (SCI(B3S, B25H, A8H, A21G)-(PGPA)₃- MC6.1C22.43) FVSQHLCGSHLVEALYLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 46-INS Analog #10 (SCI(B3S, B16H, A21G)-(PGPA)₈- MC6.1C22.43) (SCIv5-(PGPA)₈-C22.43) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 47-INS Analog #11 (SCI(B3S, B16H, A8H, A14E, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 48-INS Analog #12 (SCI(B3S, B16H, B25H, A8H, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 49-INS Analog #13 (SCI(B3S, B16H, B25H, A8H, A14E, A21G)- (PGPA)₈-MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 50-INS Analog #14 (SCI(B3S, B16R, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 51-INS Analog #15 (SCI(B3S, B16F, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALFLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 52-INS Analog #16 (SCI(B3S, B16W, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALWLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 53-INS Analog #17 (SCI(B3S, B16R, A8H, A21G)-(PGPA)₈- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 54-INS Analog #18 (SCI(B3S, B16R, B25H, A8H, A21G)-(PGPA)- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPAPGPAPGPAPGPAPGPAPGPAPGPAPGPAEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 55-INS Analog #19 (SCI(B3S, A21G)-(G4Q)₅-MC6.1C22.43) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 56-INS Analog #20 (SCI(B3S, A21G)-(PGPQ)₈-MC6.1C22.43) FVSQHLCGSHLVEALYLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 57-INS Analog #21 (SCI(B3S, B16H, B25H, A8H, A21G)-(G4Q)₅- C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 58-INS Analog #22 (SCI(B3S, B16H, B25H, A8H, A21G)-(PGPQ)₈- MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 59-INS Analog #23 (SCI(B3S, B16H, B25H, A8H, A14E, A21G)- (G4Q)₅-MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 60-INS Analog #24 (SCI(B3S, B16H, B25H, A8H, A14E, A21G)- (PGPQ)₈-MC6.1C22.43) FVSQHLCGSHLVEALHLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLEQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 61-INS Analog #25 SCI(B3S, B16R, A21G)-(G4Q)₅- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 62-INS Analog #26 SCI(B3S, B16R, A21G)-(PGPQ)₈- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCTSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 63-INS Analog #27 (SCI(B3S, B16R, A8H, A21G)-(G4Q)₅- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 64-INS Analog #28 (SCI(B3S, B16R, A8H, A21G)-(PGPQ)₈- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFFYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 65-INS Analog #29 (SCI(B3S, B16R, B25H, A8H, A21G)-(G4Q)₅- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLY LQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 66-INS Analog #30 (SCI(B3S, B16R, B25H, A8H, A21G)-(PGPQ)₈- MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPQPGPQPGPQPGPQPGPQPGPQPGPQPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 67-INS Analog #31 (SCI(B3S, B16R, B25H, A8H, A21G)- (G2E)7G2-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGEGGEGGEGGEGGEGGEGGEGGEVQLLESGGGLVQPGGSLRLSCAASGRYI DETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYLQM NSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 68-INS Analog #32 (SCI(B3S, B16R, B25H, A8H, A21G)- (G4E)4G4-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGEGGGGEGGGGEGGGGEGGGGEVQLLESGGGLVQPGGSLRLSCAASGR YIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYLQ MNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 69-INS Analog #33 (SCI(B3S, B16R, B25H, A8H, A21G)- (G4K)4G4-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGKGGGGKGGGGKGGGGKGGGGEVQLLESGGGLVQPGGSLRLSCAASG RYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYL QMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 70-INS Analog #34 (SCI(B3S, B16R, B25H, A8H, A21G)- G4(AP)10G4-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGAPAPAPAPAPAPAPAPAPAPGGGGEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 71-INS Analog #35 (SCI(B3S, B16R, B25H, A8H, A21G)- G4(EP)10G4-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGEPEPEPEPEPEPEPEPEPEPGGGGEVQLLESGGGLVQPGGSLRLSCAASG RYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTLYL QMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 72-INS Analog #36 (SCI(B3S, B16R, B25H, A8H, A21G)- G4(KP)10G4-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGKPKPKPKPKPKPKPKPKPKPGGGGEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 73-INS Analog #37 (SCI(B3S, B16R, B25H, A8H, A21G)- (PGPE)7PGPQ-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPEPGPEPGPEPGPEPGPEPGPEPGPEPGPQEVQLLESGGGLVQPGGSLRLSCA ASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNT LYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 74-INS Analog #38 (SCI(B3S, B16R, B25H, A8H, A21G)- (PGPK)7PGPQ-MC6.1C22.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGPGPKPGPKPGPKPGPKPGPKPGPKPGPKPGPQEVQLLESGGGLVQPGGSLRLS CAASGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSK NTLYLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 75-INS Analog #39 (SCI(B3K, B16R, B25H, A8H, A21G)-G4Q)5- MC6.1C22.43) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 76-INS Analog #40 (SCI(B3K, B16R, B21Q, B25H, A8H, A21G)- G4Q)5-MC6.1C22.43) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGTVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 77-INS Analog #41 (SCI(B3K, B16R, B21Q, B25H,  A4Q,  A8H, A21G)-G4Q)5-MC6.1C22.43) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKEREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 78-INS Analog #42 (SCI(B3S, B16R, B25H, A8H, A21G)-(G4Q)5-MC6.1C80.43) FVSQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLENY CGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAAS GRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 79-INS Analog #43 (SCI(B3K, B16R, B25H, A8H, A21G)-(G4Q)5-MC6.1C80.43) FVKQHLCGSHLVEALRLVCGERGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 80-INS Analog #44 (SCI(B3K, B16R, B21Q, B25H, A8H, A21G)-(G₄Q)₅-MC6.1C80.43) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVEQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 81-INS Analog #45 (SCI(B3K, B16R, B21Q, B25H, A4Q, A8H, A21G)-(G4Q)5-MC6.1C80.43) FVKQHLCGSHLVEALRLVCGQRGFHYTPKTGGGGGGGIVQQCCHSICSLYQLEN YCGGGGGQGGGGQGGGGQGGGGQGGGGQEVQLLESGGGLVQPGGSLRLSCAA SGRYIDETAVAWFRQAPGKGREFVAGIGGGVDITYYADSVKGRFTISRDNSKNTL YLQMNSLRPEDTAVYYCAARPGRPLITSKVADLYPYWGQGTLVTVSSPP SEQ ID NO: 82-Signal Peptide METDTLLLWVLLLWVPGSTG SEQ ID NO: 83-C-terminal C9 tag TETSQVAPA SEQ ID NO: 84 (CDR1 #1) AASGRTVSSTAVA SEQ ID NO: 85 (CDR1 #2) AASGRYIDSTAVA SEQ ID NO: 86 (CDR1 #3) AASGRYIDETAVA SEQ ID NO: 87 (CDR2 #1) GIGGSVDITYYLDSVKG SEQ ID NO: 88 (CDR2 #2) GIGGSVDITYYADSVKG SEQ ID NO: 89 (CDR2 #3) GIGGGVDITYYADSVKG SEQ ID NO: 90 (CDR3 #1) AVRPGRPLITSRDANLYDY SEQ ID NO: 91 (CDR3 #2) AARPGRPLITSRVANLYPY SEQ ID NO: 92 (CDR3 #3) AARPGRPLITSKVADLYPY 

1. A compound comprising a structure of: VHH-L₁-A-L₂-B, VHH-L₁-B-L₂-A, A-L₂-B-L₁-VHH, or B-L₂-A-L₁-VHH, wherein VHH comprises an amino acid sequence selected from the group consisting of SEQ ID NOS:7, 8 and 9 or a sequence having at least 90% sequence similarity thereto, wherein A is an insulin A chain comprising an amino acid sequence of SEQ ID NO:3 or a sequence having at least 90% sequence similarity thereto, wherein B is an insulin B chain comprising an amino acid sequence of SEQ ID NO:4 or a sequence having at least 90% sequence similarity thereto, wherein L₁ is a first linker comprising an amino acid sequence selected from the group consisting of SEQ ID NOS:10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 and 22, and wherein n can be from 1 to 10, and wherein L₂ is a second linker comprising an amino acid sequence selected from the group consisting of SEQ ID NOS:34, 35 and
 36. 2. The compound of claim 1, wherein A is SEQ ID NO:3.
 3. The compound of claim 1, wherein B is SEQ ID NO:4.
 4. The compound of claim 1, wherein A is SEQ ID NO:3 and B is SEQ ID NO:4.
 5. The compound of claim 1, wherein A is SEQ ID NO:3 and includes at least one mutation selected from the group consisting of an E4Q mutation, a T8H mutation, a Y14E mutation and a N21G mutation.
 6. The compound of claim 1, wherein B is SEQ ID NO:4 and includes at least one mutation selected from the group consisting of a N3D mutation, a N3K mutation, a N3S mutation, a S9A mutation, a Y16E mutation, a Y16F mutation, a Y16H mutation, a Y16R mutation, a Y16W mutation, a E21Q mutation or a F25H mutation.
 7. The compound of claim 1, wherein A is SEQ ID NO:3 and includes at least one mutation selected from the group consisting of an E4Q mutation, a T8H mutation, a Y14E mutation and a N21G mutation, and wherein B is SEQ ID NO:4 and includes at least one mutation selected from the group consisting of a N3D mutation, a N3K mutation, a N3S mutation, a S9A mutation, a Y16E mutation, a Y16F mutation, a Y16H mutation, a Y16R mutation, a Y16W mutation, a E21Q mutation or a F25H mutation.
 8. The compound of claim 1, wherein L₁ is SEQ ID NO:23.
 9. The compound of claim 1, wherein L₁ is SEQ ID NO:24.
 10. The compound of claim 1, wherein L₁ is SEQ ID NO:25.
 11. The compound of claim 1, wherein L₁ is SEQ ID NO:26.
 12. The compound of claim 1, wherein L₁ is SEQ ID NO:27.
 13. The compound of claim 1, wherein L₁ is SEQ ID NO:28.
 14. The compound of claim 1, wherein L₁ is SEQ ID NO:29.
 15. The compound of claim 1, wherein L₁ is SEQ ID NO:30.
 16. The compound of claim 1, wherein L₁ is SEQ ID NO:31.
 17. The compound of claim 1, wherein L₁ is SEQ ID NO:32.
 18. The compound of any claim 1, wherein L₁ is SEQ ID NO:33.
 19. The compound of claim 1, wherein L₂ is SEQ ID NO:34.
 20. A compound comprising an amino acid sequence selected from the group consisting of SEQ ID NOS:37 to 81 or a sequence having at least 90% sequence similarity thereto. 21-22. (canceled)
 23. A pharmaceutical composition comprising a compound of claim 1 and a pharmaceutically acceptable buffer.
 24. The pharmaceutical composition of claim 23 further comprising an additional therapeutic agent.
 25. The pharmaceutical composition of claim 24, wherein the additional therapeutic agent is selected from the group consisting of a dipeptidyl peptidase 4 (DPP-IV) inhibitor, a native amylin or analog thereof, a short-acting (prandial) INS analog, a native incretin or analog thereof, a native insulin-like growth factor (IGF) or analog thereof, metformin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, a statin, a sulfonylurea (SU), a thiazolidinedione (TZD), and other anti-glycemic agents or other anti-obesity agents.
 26. A method of treating cardiometabolic conditions, diseases and/or disorders in an individual, the method comprising the step of: administering to the individual an effective amount of the compound of claim 1 or the pharmaceutical composition of claim
 22. 27. The method of claim 26 further comprising administering to the individual an effective amount of an additional therapeutic agent.
 28. The method of claim 27, wherein the additional therapeutic agent is selected from the group consisting of a dipeptidyl peptidase 4 (DPP-IV) inhibitor, a native amylin or analog thereof, a short-acting (prandial) INS analog, a native incretin or analog thereof, a native insulin-like growth factor (IGF) or analog thereof, metformin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, a statin, a sulfonylurea (SU), a thiazolidinedione (TZD), and other anti-glycemic agents or other anti-obesity agents. 29-39. (canceled) 